Novembre - dicembre 2011 - KAM FOR SUD...Novembre - dicembre 2011 Patrick Grassi Civilista •...

Patrick Grassi • Civilista • Infermiere anestesista 1

Resoconto Health Post Saipu Novembre - dicembre 2011 Patrick Grassi Civilista • Infermiere anestesista

KAM FOR SUD


ALCUNE CONSIDERAZIONI

Prima di entrare nella parte più pratica e tecnica del resoconto del mio periodo in Nepal, vorrei condividere con chi legge qualche pensiero che ha attraversato la mia mente e qualche considerazione che mi son ritrovato a fare durante e dopo questa esperienza che ho avuto l'opportunità di vivere.

Nel mese di novembre 2011 sono arrivato in Nepal e, come in qualsiasi viaggio verso un luogo che non si conosce, la realtà che si trova, tanto o poco, differisce da ciò che uno si immagina. Questo non dipende dal tempo dedicato alla preparazione del viaggio o dalle conoscenze che si hanno della destinazione, ma dal semplice fatto che tutto ciò che abbiamo appreso é filtrato in primo luogo da chi ci narra i luoghi visitati e poi da noi stessi. Così la nostra mente vaga e senza che nemmeno ce ne accorgiamo, collega le nuove informazioni con quelle vecchie e con le esperienze precedentemente vissute e da tutto ciò si costruisce un immaginario. Se non é facile capire veramente un paese lontano fin che non ci si vive, lo può essere ancora di più far capire e spiegare ad altri una società e una situazione sanitaria complesse e a volte contraddittorie come quelle del Nepal. Io, purtroppo e mio malgrado, sono potuto restare solo due mesi in Nepal, che é un periodo relativamente breve, ma vivendolo intensamente e con sguardo attento ho cercato di cogliere e di trasmettere alcuni spunti su cui riflettere prima di decidere come contribuire a questo Health Post.

A Saipu mi sono trovato a lavorare in condizioni che, rapportate alla nostra realtà sanitaria e sociale, sono difficili da immaginare. Riporto di seguito qualche esempio per permettere al lettore di farsi un'idea. Ho curato una persona ammalata che ha affrontato un viaggio lungo e duro fino a Kathmandu per sentirsi dire: “You have blood cancer, here there's no treatment for you1” e per poi semplicemente tornare a casa a vivere la vita di tutti i giorni, avendo forse un po' più presente quanto questa sia impermanente. Ho incontrato un intoccabile che, avendo ricevuto una cornata da un bufalo, porterà a vita deformazioni che si sarebbero potute evitare con una semplice riduzione della frattura ma che, a causa dell'estrema indigenza in cui sono abituati a vivere i fuori-casta, non ha nemmeno considerato la possibilità di andare a Manthali all'ospedale o di essere curato altrimenti che con cinque punti di sutura alla pelle, eseguiti su una frattura dislocata. Ho aiutato una donna a partorire a casa sua e alla bambina che fortunatamente é nata bella e sana ho dovuto poi dare il nome, ma la stessa settimana ho sentito di una donna a Duragaun che ha partorito senza l'assistenza degli health workers ed é morta per sanguinamento postpartum dovuto a ritenzione placentare. Un parto difficoltoso l'ho poi vissuto anche di persona e il neonato infine é morto; per mia fortuna si é trattato di una capra e non di un essere umano, ma visto 1 "Ha un cancro del sangue, non c'è nessun trattamento per lei"


che a Saipu non c'é il veterinario, sono gli health workers a intervenire anche per gli animali. Oltre a pazienti nuovi, ho curato un gran numero di pazienti cronici che, dopo essere stati a Kathmandu, magari in uno dei migliori ospedali e con una spesa notevole, sono tornati a Saipu e si tengono i loro dolori e problemi con la proverbiale accettazione e serenità dei nepalesi.

Dopo poco più di due mesi di impegnativo ma soddisfacente lavoro, immerso in questa realtà, sono ritornato in Svizzera alla mia solita attività in ospedale, non senza qualche difficoltà. Difficoltà dovute da un lato a una visione diversa dei problemi e della nostra società, che si può sviluppare dopo questo genere di esperienze, e dall'altro al fatto che dopo solo due mesi di assenza mi sono trovato confrontato a concreti e grossi cambiamenti che stanno avvenendo, che si prospettano nella nostra realtà sanitaria e che avranno un forte impatto su chi lavora e anche sui pazienti. Lo swiss-drg é il nuovo metodo di finanziamento della sanità entrato in vigore quest'anno, é un nuovo strumento (dopo altri falliti negli scorsi anni) ideato per curare un sistema sanitario ipertrofico che continua a crescere, sfuggendo ai tentativi di controllo finora messi in atto. Nel nostro corpo vi é un'ipertrofia fisiologica e sana di vari sistemi-organi che si ottiene con l'allenamento, un'alimentazione sana e una vita regolare, ma vi é pure un'ipertrofia patologica dovuta ad abitudini di vita eccessive e dannose, probabilmente é di quest'ultima forma che soffre il nostro sistema sanitario. Se quello nepalese può essere paragonato a un paziente denutrito che é limitato nelle sue funzioni dalla mancanza di calorie, il nostro é invece un paziente obeso che consuma una dieta ipercalorica da troppo tempo e che sotto il suo proprio peso é diventato sedentario e non é più così reattivo e scattante nell'affrontare il proprio lavoro. Questa é una semplice constatazione e non un'accusa, la situazione é oltremodo complessa e inoltre sono convinto che ogni sistema sanitario sia lo specchio della società che lo ospita e che lo ha creato, ed é forse questo un motivo dei fallimenti dei tentativi di cambiare il nostro sistema sanitario: non lo possiamo cambiare senza cambiare la nostra società, senza cambiare noi stessi. Visto che ci apprestiamo a lavorare in un sistema sanitario nato e cresciuto in una realtà e una cultura molto diversa dalla nostra, nel progetto e nelle decisioni che saranno prese una seria riflessione su che cosa vogliamo realmente “esportare”, e in che modo, é d'obbligo!

Abbiamo da una parte un sistema precario nel quale la gente ha sviluppato, o ricevuto in eredità, una capacità di accettazione e una serenità (che non é semplice rassegnazione) che permette di affrontare ciò che la vita pone di fronte. Dall'altra un sistema iperspecializzato, più efficace da un lato, ma dal quale diventa quasi impossibile accettare un fallimento o una mancanza e al quale la gente affida il proprio desiderio di immortalità, invulnerabilità e perfezione. Obiettivi umanamente irrealizzabili, perseguiti in modo a volte perverso, a scapito proprio del benessere dei pazienti. Cosa é meglio? “Se stai male però tu non ti fai mica ricoverare in un ospedale pubblico nepalese”, già mi pare di sentirmi dire, ed é verissimo: nessuna persona sana di mente che abbia la possibilità di scegliere lo farebbe! Ma questo non vuol dire che


qualche serio problema non lo abbia anche il nostro sistema sanitario e non riconoscerlo sarebbe un grosso errore. Dove sta allora il punto di equilibrio? Il confine che separa la semplicità e l'accettazione nepalesi -in condizioni sanitarie tuttavia molto precarie- dall'eccessiva complessità e dalla perversità del nostro sistema super-specializzato? Una risposta precisa non ce l'ho, o forse nemmeno esiste, magari questo confine si supera quando gli sforzi fatti per migliorare causano più problemi che benefici... Non intendo con questo che in Nepal bisogna essere passivi e accettare la situazione così com'è senza fare niente, anzi di cose da fare e buone idee ce ne sono fin che vogliamo, ma molto più importante è l'atteggiamento con cui entreremo nella piccola realtà di Saipu. Dobbiamo entrare in punta di piedi, guardarci attorno con curiosità, pronti a lasciarci stupire e a cogliere ciò che di fantastico già esiste. Tutti gli interventi che vorremo fare dovrebbero esser volti innanzitutto a considerare e a cercare di preservare quello che i nepalesi hanno di buono e che manca a noi.

Tornando al nostro Health Post, sono convinto che abbiamo le basi per immaginare un progetto che funzioni bene, che sia di reale aiuto alla popolazione di Saipu e che si integri in modo armonioso nella realtà del Nepal rurale. Dobbiamo comunque tener conto del fatto che esso serve una popolazione di poco meno di 4'000 persone e che il nostro obiettivo dovrebbe essere quello di migliorare la qualità e le prestazioni di quello che io credo debba restare un Health Post, un ambulatorio che si occupi delle emergenze e soprattutto delle necessità di base della popolazione e che sappia indirizzare correttamente i pazienti con patologie più complesse. La posizione geografica dell'Health Post attuale é ottimale e non dovrebbe essere cambiata. La situazione attuale all'Health Post non é così disperata come forse a volte ci é stata descritta, anzi, rispetto ad altre realtà simili viste in Nepal trovo che gli operatori svolgano un buon lavoro, anche grazie al sostegno del governo in quanto a medicinali e materiale. Questo non significa che non ci sia un margine di miglioramento nelle prestazioni ed eventualmente alla struttura, ma vuol dire che abbiamo delle solide basi su cui costruire. Dovremmo prestare però attenzione a non sovrapporci alle attività già svolte, né sostituire il sostegno governativo, per non indurli a regredire, a lasciarci a carico servizi che ora funzionano senza di noi. Dobbiamo invece calibrare il nostro aiuto colmando le lacune che ci sono e ricordare comunque che la buona riuscita di un progetto dipende in ultima analisi dalle persone che vi partecipano. ”...per andare a

buon fine un progetto di cooperazione deve essere fondato su un sincero rapporto di amicizia e rispetto tra le persone coinvolte; che significa poi pari dignità, pari valore, esperienze diverse alle spalle ma fondamentalmente ugual considerazione e lo stesso, appassionato, coinvolgimento. Nessun senso di superiorità, nemmeno ben camuffato, da parte di chi porta risorse finanziarie o tecnologie all'avanguardia; nessun senso di dipendenza o inferiorità da parte di chi è materialmente più povero. Anche perché è chiaro

che non è la povertà materiale a rendere la gente più infelice…” queste parole le ho potute vivere, messe in pratica, negli altri progetti di Kam For Sud: credo che siano il segreto dei piccoli grandi successi raggiunti finora e che possano essere la chiave per il successo anche di questo progetto.


Io sono stato felice di dare l'avvio pratico a questo progetto che era in gestazione già da un po' di tempo. Ho trascorso un periodo piacevole ed ho fatto un'esperienza molto positiva, sia dal lato lavorativo che da quello umano, e mi sento legato a questo progetto, sia per la curiosità e l'interesse verso la sua futura evoluzione, sia per le persone e gli amici conosciuti che saranno coinvolti. Quindi sarei felice di poter seguire il progetto, mettere a disposizione ciò che ho appreso e dare il mio aiuto anche dalla Svizzera.


RESOCONTO

Scheda riassuntiva degli ospedali e strutture di riferimento

Nella Kathmandu Valley e a Kathmandu stessa ci sono numerosi ospedali, praticamente tutto il sistema sanitario nepalese, al di fuori degli Health Post e dei comunque piccoli ospedali distrettuali. Oltre agli ospedali pubblici ci sono innumerevoli cliniche private che fioriscono allegre nelle lacune del sistema pubblico; alcune sono ancora alla portata dei nepalesi medi, altre sono finanziariamente proibitive, riservate solo alla classe elitaria e agli stranieri. Esse spesso si appropriano dei medici migliori, formati nel settore pubblico, visti i magri stipendi che quest'ultimo offre.

Con Rajan abbiamo visitato diversi ospedali, una ventina circa: l'offerta di alcuni é molto specifica mentre per altri si sovrappone. Elenco di seguito quelli che secondo me possono essere i principali a cui fare riferimento.

• Il Tribhuvan University Teaching Hospital e il Kanti Children Hospital a Maharajganj (KTM) sono contigui. Sono ospedali pubblici ma sostenuti anche da governi stranieri e ONG internazionali, essi forniscono un trattamento buono per gli standard nepalesi (c'é anche un centro cardio-chirurgico e uno oftalmologico), senza però troppi fronzoli a livello di struttura e non sono proibitivi economicamente. Unica pecca venendo da est: bisogna attraversare tutta Kathmandu.

• Il Sahid Gangalal Heart Hospital a KTM é il centro di riferimento nazionale per la cardiologia, gestito con il sostegno di ONG e organismi internazionali (anche svizzeri) che in caso di bisogno possono fornire facilitazioni per i più poveri che non potrebbero altrimenti accedere alle cure. Stesso problema però per raggiungerlo venendo da est.

• Il Maternity Hospital a Thapathali (KTM) é l'ospedale principale per quanto riguarda la ginecologia e l'ostetricia in Nepal. Tuttavia, se non ci sono problemi gravi, é possibile e auspicabile per praticità far capo a strutture più periferiche.

• Il Tilganga Eye Hospital a Gaushala (KTM) si trova vicino all'aeroporto, quindi facilmente accessibile per chi arriva da est ed é un ottimo centro oftalmologico con sostegno e collaborazioni internazionali e una struttura ottima per gli standard nepalesi.

• Il Patan Hospital a Lagankhel (Patan) é un ospedale generico pubblico di buona qualità, sede anche dell'ufficio principale del programma di telemedicina per le zone


rurali. Quest'ultimo potrebbe diventare un contatto utile per gli health workers di Saipu ed i volontari che vi lavoreranno, ma deve essere valutato meglio (quando sono passato l'ufficio era già chiuso).

• Il Siddhi Memorial Hospital é un ospedale pediatrico e ostetrico a Bhaktapur, di buon livello, al quale già fanno capo con soddisfazione le famiglie dell'orfanotrofio-fattoria di Tathali.

• L'Handicapped Treatment Hospital a Banepa é un ospedale ortopedico e ricostruttivo di ottimo livello, sostenuto da ONG internazionali, che però si occupa solo di casi pediatrici (con qualche rara eccezione: Mana Rai, docente della Sahid Smriti school di Saipu, é stato curato qui dopo una grave caduta).

• Il Dulikhel Hospital é legato al Tribuvan Teaching Hospital: é un ospedale generico di buon livello un po' più accessibile (geograficamente) per gli abitanti di Saipu.

• Gli ospedali distrettuali di Charikot e Manthali possono essere presi in considerazione per i casi che non sono gestibili all'Health Post perché necessitano di un ricovero, ma non ci si deve aspettare troppo. Possono comunque fungere da ulteriore luogo di "triage" e indirizzare i pazienti verso centri adeguati.

L'Health Post di Saipu

All'Health Post la situazione generale non é così pessima come ci é stata a volte descritta in passato. Sopratutto grazie alle competenze del Senior Health Worker Jay Prakash Raya la qualità dei servizi offerti é superiore alla media di ciò che si può vedere generalmente nei villaggi del Nepal. Il governo fornisce agli Health Post una serie di 23 medicamenti di prima necessità definiti in una lista, con le relative indicazioni. Il governo, per lo meno stando a quanto ho osservato durante il mio soggiorno, fornisce questi medicamenti in quantità sufficiente, bisognerà eventualmente valutare la situazione nel periodo monsonico, nel quale la casistica aumenta.

Lo staff é composto da 4 persone:

Jay Prakash Raya, Senior Health Worker (SHW), ha una formazione di due anni, é il responsabile, lavora prevalentemente all'Health Post (HP) e si occupa dei casi più seri a domicilio. Riceve 14'000 NRs al mese dal governo.

Rameswar Paudel, Assistant Health Worker (AHW), ha una formazione di 3 mesi, si occupa principalmente delle vaccinazioni e di prevenzione su tutto il territorio di Saipu, sostituisce Jay all'HP quando lui non c'é, ma non sempre é in grado di fornire le medesime prestazioni. Riceve dal governo 13'000 NRs al mese.


Indira Paudel, Maternity and Child Healt Worker (MCHW), ha una formazione di 3 mesi, lavora su tutto il territorio per la pianificazione familiare e i controlli ostetrici e ginecologici. Riceve 13'000 NRs al mese dal governo.

Santa Kumar Sunuwar, Helper, non ha ricevuto nessuna formazione specifica in campo medico, si occupa di andare a Ramechhap a prendere i medicamenti o altro materiale fornito dal governo e di tutti i lavori logistici e di ordinaria manutenzione dell'HP.

Come detto, nel complesso il lavoro svolto é buono; rimane senz'altro un buon margine di miglioramento, ma rispetto ad altre realtà simili viste in Nepal la qualità delle cure prestate é superiore. Ciò dipende soprattutto dalla serietà di Jay, il SHW responsabile, che ha 15 anni di esperienza. Jay, che non é però originario di Saipu, si assenta per diverse settimane all’anno e la qualità di cure dell’Healt Post ne risente.

In particolare va migliorato l'uso dei medicamenti e degli antibiotici che potrebbe essere più parsimonioso e mirato.

Possibilità di trasferimento

Ambulanza: un'ambulanza che da Manthali viene a Dhobi (ev. a Dilauri) a poi va a Kathmandu costa circa 12'000 NRs, la comunità Sunuwar a Kathmandu ha creato un'associazione con un'ambulanza a disposizione, che per un trasporto Kathmandu-Saipu-Kathmandu chiede 10'000 NRs.

Elicottero: Un elicottero intervenuto per un soccorso a Buji 3-4 anni fa é costato circa 70'000-80'000 NRs, é probabile che i prezzi siano ulteriormente saliti.

Visti i costi elevati del trasporto, ho proposto di provare a coprire questi ultimi, assieme a quelli ospedalieri, con una micro-assicurazione comunitaria: progetto che vale sicuramente la pena approfondire.

Casistica

All'Health Post vengono visitati dai 200 ai 400 pazienti al mese circa, a seconda della stagione. Durante la stagione monsonica l'aumento di pazienti é dovuto in gran misura al peggioramento della qualità dell'acqua. Le attività svolte per la pianificazione familiare e le vaccinazioni hanno una media di circa 200-300 consultazioni al mese.

La casistica dettagliata delle patologie è illustrata nell'allegato 2.


Nel 2011 ci sono stati 72 parti a Saipu, 84 il totale delle gravidanze in corso nel mese di gennaio 2012. Di queste, solo 25 sono assistite dagli health workers. Da 4 a 6 donne all'anno partoriscono all'ospedale di Manthali.

Non sono riuscito ad avere dati precisi sulla mortalità neonatale, che non sembra comunque essere elevatissima, ma la gestione del neonato può senz'altro essere migliorata. In questo ambito Anna Christe, la prossima volontaria, potrà sicuramente essere utile.

Il tasso di mortalità delle partorienti é pure difficile da definire, con una casistica di circa 80 parti l'anno i decessi si verificano forse con una frequenza di un caso ogni due o tre anni o magari di più, ma vista la gravità della situazione e le implicazioni, qualsiasi miglioramento che possiamo portare deve essere considerato.

Vaccinazioni

Un Assistant Health Worker si occupa delle vaccinazioni e in giorni stabiliti si reca nei vari "ward" (settori) per le nuove vaccinazioni e i richiami. Le vaccinazioni fatte sono documentate in un apposito registro dell'Health Post. A livello teorico i bambini (e anche gli adulti, sembra) hanno anche una cartella personale delle vaccinazioni. Io non ne ho mai vista una e penso che se anche questa venisse realmente introdotta, avrebbe comunque una vita breve e travagliata e difficilmente resisterebbe fino al primo o ai seguenti richiami.

Struttura fisica e posizione

La struttura fisica dell'Health Post é in grado di svolgere il suo ruolo in modo funzionale, è tuttavia possibile pensare a delle migliorie.

Possiamo pensare all'ampliamento della struttura con la creazione di un "birthing center". Da un punto di vista puramente numerico e statistico potrebbe sembrare forse eccessivo (in media c'é un parto e mezzo alla settimana di cui solo uno ogni due settimane assistito dagli health workers), ma dobbiamo considerare soprattutto le possibili serie conseguenze, anche se non così frequenti, di un parto problematico.

Uno dei problemi sanitari in Nepal è rappresentato dagli "ausadhi shop", una specie di farmacie che, se da un lato rendono disponibili i farmaci che il governo non fornisce, dall'altro li distribuiscono senza criterio e con più attenzione agli interessi economici del proprietario che alla salute del paziente... A Saipu non ne esiste ancora uno, e questo é un bene, perché ci dà l'opportunità di aprirne uno comunitario sotto la


supervisione di Kam For Sud, prima che ci pensi qualcun altro. Questo con il vantaggio di frenare la distribuzione indiscriminata di antibiotici e altri medicamenti, vendendoli solo quando esiste una reale indicazione. L'idea sarebbe di vendere i medicamenti che il governo non fornisce ad un prezzo simile a quello degli "ausadhi shop" della regione, ma l'eventuale guadagno verrebbe reinvestito nell'Health Post o nel sostegno a pazienti che non hanno i mezzi per comperare i medicamenti. Nel progetto di ampliamento dell'HP si potrebbe riservare uno spazio a questo, magari nella struttura attualmente operativa.

Come detto, l'Health Post si trova in una posizione ottimale, centrale rispetto al territorio di Saipu e collegato alla strada (attualmente in costruzione). È in un posto tranquillo, su un crinale con una bella vista e la deviazione dalla strada principale (che passa a 500 m di distanza) terminerà all'Health Post, evitando così il disturbo del traffico di passaggio. Gli altri possibili siti che ci sono stati proposti hanno alcuni svantaggi, come la minor centralità o la vicinanza con la scuola, che creerebbe più confusione e rumore attorno all'Health Post e un possibile incremento del consumo non necessario di medicamenti da parte degli scolari (problema che già in piccola misura esiste).

Cartella medica

Attualmente all'Health Post vengono registrati tutti i casi in un registro contenente le vaccinazioni, le consultazioni di pianificazione famigliare e i pazienti ambulatoriali; per questi ultimi vi é inoltre un apposito registro dove figura il motivo della consultazione e la terapia.

In Nepal non vi é nessun obbligo da parte delle strutture sanitarie, nemmeno per gli ospedali più grandi, di conservare la documentazione relativa ai pazienti. I risultati degli esami e delle indagini vengono consegnati ai pazienti al termine del trattamento. Nelle cliniche private più efficienti esiste la possibilità di creare una cartella personale conservata dall'ospedale, probabilmente a pagamento.

Per questi motivi introdurre una cartella clinica, come la concepiamo noi, in un isolato Health Post, potrebbe essere difficile. All'Health Post non vengono svolte indagini paracliniche e quindi la cartella conterrebbe solo valutazioni semeiotiche, facilmente ricostruibili in caso di ritorno del paziente, mentre gli esami paraclinici svolti altrove vengono conservati dal paziente stesso.


Orari

L'Health Post è aperto tutti i giorni dalla domenica al venerdì, dalle 10:00 alle 14:00; il sabato, giorno di riposo, l'Health Post rimane chiuso. Per la casistica e le abitudini culturali nepalesi questi orari sono sufficienti a coprire le necessità. Si può pensare ad un eventuale prolungamento dell'orario di apertura il pomeriggio nel periodo monsonico o nei giorni con più affluenza, ma in realtà già ora se ci sono pazienti in più gli health workers rimangono in sede fino a quando sono stati visitati tutti e non fino all'orario di apertura ufficiale. Se ci sono dei casi gravi gli health workers sono mandati a chiamare e assistono il malato a casa in qualsiasi orario.

Propongo di lasciare le cose come stanno, evitando magari di creare problemi o malcontenti dove le cose in fondo funzionano.

Agopuntura

Durante il periodo trascorso a Saipu ho potuto trattare molti pazienti con l'agopuntura. Ho cominciato per necessità, in casi abbastanza seri e per i quali non erano disponibili medicine o un trattamento adatto. All'inizio sia i pazienti che gli health workers erano scettici e soprattutto i pazienti erano piuttosto reticenti a farsi pungere e curare con degli aghi. Tuttavia alcune persone, visto che non c'erano alternative valide, hanno cominciato a farsi curare in questo modo e, grazie ai risultati ottenuti e al passaparola, in poche settimane sono arrivato a consultare fino a 50 o più pazienti al giorno. Molte persone venivano anche dai villaggi o dal distretto vicini, al costo di qualche ora di cammino, per farsi curare con l'agopuntura.

Patologie come ad esempio la BPCO2, dolori articolari, problemi ginecologici sono frequenti a Saipu: con i mezzi disponibili attualmente i pazienti non ricevono un gran beneficio e con accettazione continuano la loro vita come possono. Con l'agopuntura si può fornire loro un notevole miglioramento della qualità di vita. In luoghi isolati come Saipu, l'agopuntura é economica e pratica e con “un solo strumento” copre una notevole gamma di patologie. Per avere un'idea più precisa delle patologie che si possono trattare con l'agopuntura, consultare il documento dell'OMS (allegato 3).

Sia il comitato dell'HP, a rappresentanza del sistema sanitario di Saipu, sia il “Village Development Committee”di Saipu, a rappresentanza dei pazienti, hanno richiesto per iscritto a Kam For Sud che in futuro venga dato spazio e sostegno a questa disciplina (allegato 1).

2 Broncopneumopatia cronica ostruttiva


CONCLUSIONI

L'esperienza che ho potuto fare in Nepal é stata più che positiva, é stato uno scambio, nel quale quello che ho ricevuto é più di ciò che ho potuto dare. Credo che sia con questo spirito che dovremmo proseguire con il progetto dell'Health Post. Se é vero che in Nepal la sanità ha un buon margine di sviluppo, é anche vero che possiamo pure imparare qualcosa da questa società e cultura con radici profonde e diverse dalle nostre. Ad esempio la consapevolezza della caducità e dell’impermanenza della vita, che in ambito sanitario produce una differente visione della malattia e della salute, favorendo l’accettazione o la serenità in situazioni difficili.

Le speranze nella nostra società le affidiamo alla medicina, quale infallibile riparatrice del nostro corpo-macchina e con la ricerca che ci fornisce sempre più “pezzi di ricambio” coltiviamo l'utopia che per renderci immortali sia sufficiente riparare le cellule che ci compongono, vuotando così il contenitore del suo contenuto, rendendoci degli infallibili e invincibili infelici. Per migliorare la nostra salute collettiva come società dovremmo cominciare a ridare valore alla nostra dimensione umana, fragile e bisognosa di serenità più che di interventi di punta. La consapevolezza di questa dimensione umana in Nepal (e non solo, non è una questione geografica!) esiste ancora, forse in maniera inconscia, ma é messa in pericolo dal sistema consumistico che a grandi passi si fa avanti anche in Asia, appiattendo le differenze. È perciò nostra responsabilità considerare questi aspetti, oltre a quelli prettamente pratici e tecnici, pensando a ciò che si vuole fare a Saipu.

Oltre all'aspetto più filosofico riportato qui sopra, sempre nell'ottica di una visione globale, vorrei riportare quelli che sono i determinanti della salute, cioè quei fattori oggettivi che contribuiscono alla buona salute di ogni persona. Questo perché nell'immaginario comune, sia da parte dei fruitori, sia da parte di chi li fornisce, ai servizi sanitari é attribuita un'importanza eccessiva. Dando un'occhiata a questo semplice schema è possibile farsi un'idea di quanto contribuisca in realtà il sistema sanitario alla nostra salute. Se lo confrontiamo con i costi che genera...


Questo non vuol dire che non sia saggio investire nel miglioramento dei servizi sanitari, ma che dovremmo collocarli al giusto posto e che l'impiego delle risorse deve essere oculato e commisurato alla realtà in cui si opera.

Ringrazio Kam For Sud e il servizio civile per la stupenda opportunità che ho avuto e rinnovo la mia volontà di mettermi a disposizione per il seguito di questo progetto, visto che in questo resoconto non ho potuto mettere che qualche piccolo spicchio di ciò che avrei voluto.


ALLEGATO 1: lettere del comitato dell'Health Post e del VDC di Saipu a Kam For Sud

DISTRICT HEALTH OFFICE RAMECHHAP SUB HEALTH POST, SAIPU

Jan 1st, 2012

To Kam For Sud Switzerland

Subject: Request for the continuation of support

Kam For Sustainable Development Switzerland supported the Saipu sub health post Ramechhap through Mr. Patrick Grassi (Resident of Via Luina 58, CH-6780 Airolo, Ticino, Switzerland). Mr. Grassi has provided the service to the people of Saipu and its surroundings through the technique of Acupuncture from October 30th, 2011 to Jan 1st 2012. He has served in average 30 to 35 patients daily and altogether given service to 750 patients through the technique of acupuncture. Since the acupuncture way of treating patients seems effective for the people of Saipu and its surroundings, when health workers are sent from Kam For Sud our expectation is to have health workers who also know the acupuncture way of treating and for the extension of the service of this sub health post we would like to request financial and other support for modern facilities, building and provision of quality training in acupuncture and others.

Jay Prakash Raya ,

Senior Health Worker Saipu

OFFICE OF THE VILLAGE DEVELOPMENT

COMMITTEE, SAIPU, RAMECHHAP

Dec 29th , 2011

Subject: To whom it may concern

Kam For Sud Switzerland supported the Saipu sub health post in Ward no. 6, Ramechhap, through Mr. Patrick Grassi (Resident of Via Luina 58, CH-6780 Airolo, Ticino, Switzerland) from Oct 30th 2011 to Dec 29th, 2011. Mr. Grassi has provided the volunteer service to the people of Saipu and its surroundings through the technique of Acupuncture, of which 30 to 35 patients benefitted daily. Since thie acupuncture way of treating patients seems effective for the people of Saipu and its surroundings, when health workers are sent from Kam For Sud our expectations is to have health workers who also know the acupuncture way of treating. We are very much grateful to Mr. Patrick Grassi and would like to thank to him from our heart and wish him all the best in the days ahead.

Since we are facing a lack of proper physical infrastructures in such a poor country like Nepal, we would like to request financial and other kind of support for modern facilities, building and provision of quality training in acupuncture and others for our Sub health post Saipu.

Keshav Prasad Timalsina

Secretary , Saipu V. D. C.


ALLEGATO 2: casistica delle patologie incontrate all'Health Post di Saipu


ALLEGATO 3: patologie che si possono trattare con l'agopuntura, secondo uno studio dell'OMS3

The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories as shown below.

1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:

Adverse reactions to radiotherapy and/or chemotherapy Allergic rhinitis (including hay fever) Biliary colic Depression (including depressive neurosis and depression following stroke) Dysentery, acute bacillary Dysmenorrhoea, primary Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm) Facial pain (including craniomandibular disorders) Headache Hypertension, essential Hypotension, primary Induction of labour Knee pain Leukopenia Low back pain Malposition of fetus, correction of Morning sickness Nausea and vomiting Neck pain Pain in dentistry (including dental pain and temporomandibular dysfunction) Periarthritis of shoulder Postoperative pain Renal colic Rheumatoid arthritis Sciatica Sprain Stroke Tennis elbow

3 Acupuncture: Review And Analysis Of Reports On Controlled Clinical Trials. The entire document can be downloaded from: http://apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf


2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:

Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm) Acne vulgaris Alcohol dependence and detoxification Bell’s palsy Bronchial asthma Cancer pain Cardiac neurosis Cholecystitis, chronic, with acute exacerbation Cholelithiasis Competition stress syndrome Craniocerebral injury, closed Diabetes mellitus, non-insulin-dependent Earache Epidemic haemorrhagic fever Epistaxis, simple (without generalized or local disease) Eye pain due to subconjunctival injection Female infertility Facial spasm Female urethral syndrome Fibromyalgia and fasciitis Gastrokinetic disturbance Gouty arthritis Hepatitis B virus carrier status Herpes zoster (human (alpha) herpesvirus 3) Hyperlipaemia Hypo-ovarianism Insomnia Labour pain Lactation, deficiency Male sexual dysfunction, non-organic Ménière disease Neuralgia, post-herpetic Neurodermatitis Obesity Opium, cocaine and heroin dependence Osteoarthritis Pain due to endoscopic examination Pain in thromboangiitis obliterans Polycystic ovary syndrome (Stein-Leventhal syndrome) Postextubation in children Postoperative convalescence Premenstrual syndrome Prostatitis, chronic Pruritus Radicular and pseudoradicular pain syndrome Raynaud syndrome, primary Recurrent lower urinary-tract infection


Reflex sympathetic dystrophy Retention of urine, traumatic Schizophrenia Sialism, drug-induced Sjögren syndrome Sore throat (including tonsillitis) Spine pain, acute Stiff neck Temporomandibular joint dysfunction Tietze syndrome Tobacco dependence Tourette syndrome Ulcerative colitis, chronic Urolithiasis Vascular dementia Whooping cough (pertussis)

3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:

Chloasma Choroidopathy, central serous Colour blindness Deafness Hypophrenia Irritable colon syndrome Neuropathic bladder in spinal cord injury Pulmonary heart disease, chronic Small airway obstruction

4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:

Breathlessness in chronic obstructive pulmonary disease Coma Convulsions in infants Coronary heart disease (angina pectoris) Diarrhoea in infants and young children Encephalitis, viral, in children, late stage Paralysis, progressive bulbar and pseudobulbar


Summary table of controlled clinical trials This section provides a tabulated summary of all the controlled clinical trials reviewed for this publication. For each study, information is provided on the author(s), the year of publication, the number of subjects involved, the study design, the type of acupuncture applied, the controls used and the results obtained.

Condition/Study No. Design Test group Control Group Results

Abdominal pain in acute gastroenteritis (see also Gastrointestinal spasm) Shu et al., 1997 (67)

25:25 Randomized controlled trial

Body acupuncture (manual)

Routine Western medication (intra-muscular atropine and promethazine)

Relief of pain was observed in: • 24 of the test group, starting 1.3 min after acupuncture • 17 of the control group, starting 11. 9 min after injection.

Acne vulgaris Li et al., 1998 (228)



Herbal medication After 30 days of treatment, a cure was observed in: • 42.8% of the test group • 19.0% of the control group.

Wang et al., 1997 (229)

32:20 Group comparison

Auricular acupuncture

Medication (oral vitamin B6 and antibiotics, local benzoyl peroxide ointment)

Acne disappeared after 10 days of treatment in: • 19/32 (59%) in the test group. • 7/20 (35%) in the control group.

Adverse reactions to radiotherapy and/or chemotherapy (see also Leukopenia (this includes leukopenia caused by chemotherapy); Nausea and vomiting) Xia et al., 1984 (237)


Acupuncture during radiotherapy

Radiotherapy Acupuncture greatly lessened digestive and nervous system reactions (anorexia, nausea, vomiting, dizziness, and fatigue) due to radiotherapy and showed protection against damage to haematopoiesis.


Chen et al., 1996 (232)


Manual plus electric acupuncture

Western medication (metoclopramide, etc.)

Gastrointestinal reactions were cured in significantly more of the acupuncture group: • 93.2% of test group after 5.8 ± 2.7 days of treatment • 65.2% of control group after 9.4 ± 3.4 days of treatment.

Liu et al., 1998 (235)


Magnetic plus electric acupoint stimulation

Western medication (metoclopramide, etc.)

Acupoint stimulation therapy was comparable with intravenous metoclopramide for gastrointestinal reactions, and with dexamethasone and cysteine phenylacetate (leucogen) for leukopenia. The treatment was effective in: • 87.5% of the test group • 75.0% of the control group.

Wang et al., 1997 (236)

90 Randomized crossover study


Western medication (metoclopramide)

The treatment was effective in: • 85.6% of the test group • 61.1% of the control group.

Li et al., 1998 (234)



Intravenous injection of albumin, milk fat and amino acid

Natural killer cell activity and interleukin-2 were raised in the test group, but markedly lowered in the control group. During the 3-week observation period there was: • no significant change of leukocyte and thrombocyte counts in the test group • considerable lowering of both counts in the control.

Alcohol dependence, see Dependence, alcohol Alcohol detoxification Thorer et al., 1996 (212)

35 Sham controlled trial

Acupuncture at two different traditional point combinations

Acupuncture at a sham point or no acupuncture

Clinical measurement using tests of equilibrium and ntation, and specific tests of metabolism and elimination of alcohol, formed the basis of the comparison. There was no difference between the sham acupuncture and no acupuncture control groups. After both traditional acupuncture point combinations, clinical effects of alcohol intoxication were minimized, while the alcohol level in the expired air increased and blood alcohol decreased.

Allergic rhinitis (including hay fever) Chari et al., 1988 (111)


Acupuncture Antihistamine (chlorphenamine)

The treatment effects were better and lasted longer in the test group and produced no adverse effects.


Jin et al., 1989 (113)


Acupuncture plus moxibustion

Medication (patent herbal combination: tablets containing Herba Agastachis and Flos Chrysanthemi Indici)

At follow-up 1 month after 15 days of treatment improvement was observed in: • 92/100 in the test group • 47/60 in the control group.

Huang, 1990 (112)



Antihistamine (chlorphenamine)

Treatment for 14 days was effective in: • 97% of the test group • 75.8% of the control group.

Wolkenstein et al., 1993 (247)


Acupuncture Sham acupuncture The results did not indicate a protective effect of acupuncture therapy against allergen-provoked rhinitis.

Yu et al., 1994 (115)


Acupuncture Antihistamine (oral astemizole plus nasal drip 1% ephedrine)

At follow-up 1 year after 4 weeks of treatment, improvement was observed in: • 94% of the test group • 76.7% of the control group.

Liu, 1995 (114) 50:30 Randomized controlled trial

Acupuncture at biqiu (located at the round prominence on the lateral mucous membrane of the lateral nasal cavity)

Nasal drip of cortisone plus ephedrine

The treatment was significantly more effective in the test group. Effective rates were: • 86.0% in the test group • 76.7% in control group.

Williamson et al., 1996 (116)

102 Randomized controlled trial

Acupuncture Sham acupuncture The therapeutic effects were similar in the two groups. In the 4-week period following the first treatment, remission of symptoms was seen in: • 39% of the test group; mean weekly symptom scores, 18.4; mean units of medication used, 4.1 • 45.2% of the control group; mean weekly symptom scores, 17.6; mean units of medication used, 5.0.

Angina pectoris, see Coronary heart disease (angina pectoris) Aphasia due to acute cerebrovascular disorders (see also Dysphagia in pseudobulbar paralysis)


Zhang et al., 1994 (102)


Scalp acupuncture Conventional supportive measures

Assessed by a scoring method, the therapeutic effect was much better in the test group than in the control group. Before treatment, the two groups were comparable in various respects, including causal diseases and area of lesions.

Arthritis, see Gouty arthritis; Osteoarthritis; Peri rthritis of shoulder; Rheumatoid arthritis Asthma, see Bronchial asthma Bell’s palsy You et al., 1993 (106)


Blood-letting acupuncture

Medication (vasodilator plus steroid, etc.)

A cure was achieved in: • 96% of the test group • 68% of the control group.

Lin, 1997 (105) 198:60 Group comparison

Through acupuncture (puncture of two or more adjoining points with one insertion)

Traditional acupuncture After a 2-week treatment the cure rate was: • 90.9% in the test group • 76.7% in the control group.

Biliary colic (see also Cholecystitis, chronic, with acute exacerbation) Mo, 1987 (62) 70:76 Group

comparison Acupuncture Medication (injection of

atropine plus pethidine The analgesic effect was better in the test group than in the control group.

Yang et al., 1990 (64)


Electric acupuncture Medication (injection of anisodamine (a Chinese medicine, structurally related to atropine, isolated from Anisodus tangutica) plus pethidine)

Total relief of colic was achieved in 1-3 min in: • 36/50 (72%) in the test group • 12/50 (24%) in the control group. Partial relief was achieved in 5-10 min in: • 10/50 in the test group • 32/50 in the control group.

Wu et al., 1992 (63)

142 Group comparison

Acupuncture Anisodamine The treatment was effective in: • 94.3% of the test group • 80.0% of the control group.

Bladder problems, see Female urethral syndrome; Neuropathic bladder in spinal cord injury Breathlessness in chronic obstructive pulmonary disease


Jobst et al., 1986 (127)


Acupuncture Placebo acupuncture (needling at non-acupuncture “dead” points)

After 3 weeks of treatment, the test group showed greater benefit in terms of subjective scores of breathlessness and 6-min walking distance. Objective measures of lung function were unchanged in both groups.

Bronchial asthma Yu et al., 1976 (123)

20 Randomized cross-over

Acupuncture Isoprenaline or sham acupuncture

Isoprenaline was more effective than real acupuncture. Both were more effective than sham acupuncture.

Tashkin et al., 1977 (121) (methacholine-induced)

12 Randomized cross-over

Acupuncture Isoprenaline or placebo Isoprenaline was more effective than acupuncture. Both were more effective than placebo.

Fung et al., 1986 (119) (exercise-induced)

19 Randomized single-blind crossover

Acupuncture Sham acupuncture Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture.

Tandon et al., 1989 (125) (histamine-induced)

16 Double-blind cross-over

Acupuncture Acupuncture at irrelevant points

Treatment with real or placebo acupuncture failed to modulate the bronchial hyperreactivity to histamine, suggesting that a single treatment is unlikely to provide improvement in the management of acute bronchial asthma.

He et al., 1994 (120)

48:48 Randomized group comparison

Laser acupuncture Moxibustion at same points as laser acupuncture

Pulmonary ventilation indices improved in: • 33 of the test group • 20 of the control group.

Xie et al., 1996 (122)

100 Randomized controlled trial with partial crossover

Electric acupuncture at fèishû (BL13) (n = 30)

Electric acupuncture at shàoshâng (LU11) (n =24) yújì (LU10) (n = 24), tàiyuân (LU9) (n = 30), jîngqú (LU8) (n = 28), lièquç (LU7) (n = 28) or qiûxû (GB40) (n = 24)

An anti-asthmatic effect was observed in: • 28/30 of the test group (BL13); best immediate effect • 20/24 LU11, 22/24 LU10, 24/30 LU9, 24/28 LU8, 21/28 LU7; good effect 4/24 GB40; least effect.


Biernacki et al., 1998 (248) (stable asthma)

23 Randomized controlled trial, double-blind crossover

Acupuncture Sham acupuncture There was no improvement in aspects of respiratory function measured after acupuncture or sham acupuncture. There was significant improvement in the Asthma Quality of Life Questionnaire and a parallel reduction in bronchodilators.

Bulbar paralysis after stroke (see also Dysphagia in pseudobulbar paralysis) Ding, 1996 (249) 120:30 Group

comparison with comparable conditions

Acupuncture Conventional Western medication (troxerutin, piracetam, Cerebrolysin: a brain peptide preparation)

Average recovery time was: • 91 (75.8%) in test group after 5.6 days of treatment • 12 (40%) in control group after 12 days of treatment.

Cancer pain Dang et al., 1995 (230) (stomach carcinoma)


Acupuncture Western medication (codeine, pethidine)

Acupuncture treatment had: • immediate analgesic effect similar to Western medication • more marked analgesic effect than Western medication after long-term use for 2 months.

Dan et al., 1998 (231)

34:37:42 Group comparison

Body acupuncture or acupuncture plus medication

Medication (analgesic steps recommended by WHO)

An analgesic effect was observed in: • 50.0% of the medication group • 73.0% of the acupuncture group • 92.2% of acupuncture plus medication group.

Cardiac neurosis Zhou, 1992 (178) 30:30 Randomized

controlled trial

Acupuncture at rényíng (ST9)

Medication (propranolol)

At follow-up I month after 10 days of treatment the therapeutic effect was better in the test group than in the control group.

Cardiopulmonary disease, see Breathlessness in chronic obstructive pulmonary disease; Cardiac neurosis; Coronary heart disease (angina pectoris); Pulmonary heart disease, chronic Cerebrovascular disorders, see Aphasia due to acute cardiovascular disorders; Bulbar paralysis after stroke; Coma; Craniocerebral injury; Stroke Chloasma


Luan et al., 1996 (224)


Auricular acupuncture plus acupressure

Vitamins C and E After 3 months of treatment cure was achieved in: • 53.3% of the test group • 13.3% of the control group. The treatment was effective in: • 95.0% of the treatment group • 43.3% of the control group.

Cholecystitis, chronic, with acute exacerbation (see also Biliary colic) Gong et al., 1996 (139)


Body plus ear acupuncture

Conventional Western medication (unspecified)

Clinical cure (disappearance of symptoms and signs, and marked improvement of gallbladder motor function as shown by ultrasonic examination) was achieved in: • 92.5% of the test group • 32.1% of the control group.

Cholelithiasis Zhao et al., 1979 (138)


Electric acupuncture plus oral magnesium sulfate

Oral magnesium sulfate Stones were excreted in: • 409/522 (78.4%) in the test group • 20/74 (27.4%) in the control group.

Chronic obstructive pulmonary disease, see Breathlessness in chronic obstructive pulmonary disease Cocaine dependence, see Dependence, opium, cocaine, heroin Colour blindness Cai, 1998 (250) 44:65: 53 Group

comparison Body acupuncture or ear acupressure

No treatment After 1-3 courses of treatment (7-12 days each course), colour discrimination was improved: • from 0.24 to 0.46 in acupuncture group • from 0.27 to 0.52 in ear acupressure group. There was no improvement in the control group (change from 0.28 to 0.30).

Coma


Frost, 1976 (108) 17:15 Group comparison with similar levels of coma

Acupuncture at shéntíng (GV24) and shu?gôu (GV26)

No acupuncture A neurological recovery of 50% or more (significant difference) was observed in: • 59% of the test group • 20% of the control group.

Competition stress syndrome Que et al., 1986 (196)


Auricular acupressure

Psychotherapy plus placebo drug


Convulsions in infants and young children due to high fever He et al., 1997 (215)


Acupuncture at hég? (LI4)

Intramuscular phenobarbital

Convulsions stopped 2 min after starting treatment in: • 98% of the test group • 51% of the control group.

Coronary heart disease (angina pectoris) Ballegaard et al., 1986 (180)


Acupuncture Sham acupuncture (insertion of needles outside the meridians)

Cardiac work capacity (difference in pressure-rate product (dPRP)) between rest & maximum exercise & maximum PRP during exercise, was measured. No adverse effect was observed. Patients receiving active acupuncture showed significant increase in cardiac work capacity compared to those receiving sham acupuncture.

Ballegaard et al., 1990 (181)


Acupuncture Sham acupuncture There was a median reduction of 50% in anginal attack rate and glyceryl trinitrate consumption in both groups, with no significant difference between the groups. The increase in exercise tolerance and delay of onset of pain was significant in the test group; there were no significant changes in the control group.

Xue et al., 1992 (186)


Acupuncture Medication (nifedipine plus isosorbide dinitrate)

Acupuncture was more effective in improving symptoms and ECG and pulse doppler ultrasonocardiography indices.


Mao et al., 1993 (184)


Acupuncture plus conventional medication

Conventional medication (glyceryl trinitrate, aspirin, calcium antagonist)

Improvement in symptoms and ECG, respectively, were observed in: • 85.7% and 69% of the test group • 57.1% and 38% of the control group.

Dai et al., 1995 (182)


Auricular acupuncture at point heart

Auricular acupuncture at point stomach

Marked relief of angina pectoris and other symptoms, with improvement of ECG & haemorrheological indices was observed in the test group. There was no such effect in the control group.

Cheng, 1995 (183)



Conventional medication (glyceryl trinitrate, etc.)

A marked effect (no recurrence of angina during the 4-5 weeks of treatment) was observed in: • 74% of the test group • 52% of the control group.

Ma et al., 1997 (251)


Body acupuncture plus routine Western medication (aspirin, nitrates and calcium antagonist)

Routine Western medication (aspirin, nitrates and calcium antagonist)

After 10 days of hospitalization and treatment, improvement in angina pectoris and ST-T, respectively, was observed in: • 85.7% and 69% of the test group • 58.3% and 33.3% of the control group. Levels of serotonin, noradrenaline and dopamine were higher than normal in both groups but were significantly lowered only in test group after the treatment.

Craniocerebral injury, closed Ding et al., 1997 (252)


Body acupuncture Routine Western medication (unspecified)

After 15 days of treatment, clinical cure (disappearance of the main clinical symptoms and signs, and basic recovery of functions) was observed in: 86% of the test group 56% of the control group.

Deafness, sudden onset Wang et al., 1998 (218)


Body acupuncture plus routine Western treatment (dextran, dexamethasone, etc.)

Routine Western medication (dextran, dexamethasone, etc.)

After 2 weeks of treatment, the effect was highly statistically significant in: • 90% of the test group • 70% of the control group.

Defective ejaculation, see Male sexual dysfunction, non-organic


Shui, 1990 (148) 30:30: 40 Randomized controlled trial

Acupuncture Herbal medication or the Goboes and Liu regimens (treatment included sex instruction, electric massage, hormonal therapy and injection of strychnine and galantamine

After 1 month of treatment, the cure rate was: • 83.3% in the test group • 56.7% in the herbal medication group • 12.5% in the control Goboes and Liu regimen group.

Dental pain Sung et al., 1977 (78) (postoperative)


Acupuncture plus placebo drug

Sham acupuncture plus placebo drug, sham acupuncture plus codeine, or acupuncture plus codeine

Acupuncture plus placebo drug gave significantly greater pain relief than sham acupuncture plus placebo drug or sham acupuncture plus codeine. Acupuncture plus placebo drug was more effective than acupuncture plus codeine in initial 30 min after surgery; less effective 2-3 h after surgery.

Zheng et al., 1990 (79) (after pulp devitalization)



No treatment After 48 h, there was no pain in: • 12/15 (80%) in the test group • 4/11(36%) in the control group.

Lao et al., 1995 (77) (after tooth extraction)


Acupuncture Placebo acupuncture Subjects treated with acupuncture reported a significantly longer period without pain and experienced less intense pain than controls.

Sukandar et al., 1995 (80) (apical periodontitis)


Electric acupuncture Mock electric acupuncture

Analgesic effect lasting 24 h was obtained in: • 65% of the test group • 10% of the control group.

Lao et al., 1999 (73) (after oral surgery)


Acupuncture Placebo acupuncture Acupuncture was statistically significantly superior to the placebo in preventing postoperative dental pain. Mean pain-free postoperative time and minutes before requesting pain relief medication, respectively, were: • 172.9 min and 242.1 min in the test group • 93.8 min and 166.2 min in the placebo group.

Dependence, alcohol


Bullock et al., 1987 (210)


Acupuncture at specific points

Acupuncture at non-specific points

There was a significant difference between the two groups at the end of the study; patients in the test group expressed less need for alcohol, with fewer drinking episodes.

Bullock et al., 1989 (211)


Acupuncture at specific points

Acupuncture at non-specific points

Significant treatment effects persisted at the end of the 6-month follow-up; more control patients expressed a moderate-strong need for alcohol and had more than twice the number of drinking episodes & admissions to detoxification centres.

Dependence, opium, cocaine and heroin Margolin et al., 1993 (201) (cocaine)

32 per group

Group comparison (post hoc)

Auricular Desipramine, amantadine or drug placebo

Abstinence rates during final 2 weeks of 8-week treatment were: • auricular acupuncture 44% • desipramine 26% • amantadine 15% • drug placebo 13%.

Washburn et al., 1993 (202) (heroin)


Acupuncture Sham acupuncture Self-reported frequency of heroin use was lower in the test group.

Cai et al., 1998 (200) (heroin, late stage of abstinence)


Body acupuncture Vitamin B1 Reduction of anorexia, spontaneous sweating and insomnia in the late stage of abstinence was greater in test group, and statistically significant.

Bullock et al., 1999 (199) (cocaine)



Acupuncture at sham ear points or conventional treatment without acupuncture

The data failed to identify significant treatment differences among the various groups.

Dependence, tobacco


Fang, 1983 (204) 33:28 Randomized controlled trial (patients told they were receiving acupuncture for other purposes)


Body acupuncture Under a regime of passive abstinence with no suggestion or motivation, auricular acupuncture was superior to body acupuncture in reducing the tobacco consumption by more than half in: • 70% of the auricular acupuncture group (72% experienced disgust at the taste of tobacco and 15% felt dizzy during smoking) • 11% of the body acupuncture group.

Clavel et al., 1985 (253)

224:205: 222

Randomized group comparison

Acupuncture Nicotine gum or minimal intervention (cigarette case with lock controlled by a time switch, which could be regulated at will)

Acupuncture and nicotine gum did not reduce the tendency to relapse after one month but were effective in helping smokers to stop smoking during the first month in: • 43/224 in the acupuncture group • 46/205 in the group receiving nicotine gum • 8/222 in the minimal intervention group.

He et al., 1997 (205)


Acupuncture at points used to assist smoking cessation

Acupuncture at points assumed to have no effect on smoking cessation

Daily cigarette consumption fell during the treatment in both groups, but the reduction was larger in the test group. Serum concentrations of cotinine and thiocyanate were significantly reduced after the treatment period in the test group but not in the control group.

White et al., 1998 (207)


Electric acupuncture at appropriate points in each ear

Sham procedure (auricular acupuncture over the mastoid bone)

There was no significant difference between the two groups in the mean score for reduction of withdrawal symptoms.

Waite et al., 1998 (206)


Electric acupuncture plus self-retained ear seed (a herbal seed used to apply pressure to the point) at an active site

Auricular acupuncture plus self-retained ear seed at a placebo site

The test acupuncture was significantly more effective in helping volunteers to quit smoking than the control treatment. Cessation of smoking at 6 months in: • 12.5% of the test group • 0% of the control group.

Depression (see also Depression after stroke)


Luo et al., 1985 (191)


Electric acupuncture Medication (amitriptyline)

There was a similar improvement in the two groups but far fewer side-effects in the test group.

Luo et al., 1988 (192)

133:108 Multicentre, randomized controlled trial

Electric acupuncture Medication (amitriptyline)

There was a similar improvement in the two groups but a greater effect on anxiety and fewer side-effects in the test group.

Yang et al., 1994 (193)


Acupuncture Medication (amitriptyline)

There was a similar improvement in the two groups after 6 weeks.

Luo et al., 1998 (254)


Electric acupuncture plus placebo

Electric acupuncture plus amitriptyline

The therapeutic efficacy was similar in the two groups for depressive disorders. The therapeutic effect for anxiety somatization and cognitive process disturbance was greater and there were fewer side-effects in the test group.

Depression after stroke Li et al., 1994 (190)

34:34: 33 Randomized controlled trial

“Antidepressive” acupuncture (different selection of points)

Medication (doxepin) plus traditional acupuncture or traditional acupuncture alone

There was a similar improvement in the anti-depressive acupuncture and medication plus traditional acupunture groups; improvement was superior to that in traditional acupuncture group.

Hou et al., 1996 (189)

30:30 Randomized controlled trial with independent assessment

Electric acupuncture at bãihuì (GV20) and yìntáng (EX-HN3)

Traditional manual acupuncture

The results were better in the test group; the difference was significant as assessed by the Hamilton and other scoring methods.

Depressive neurosis Zhang, 1996 (194)

31 per group

Randomized controlled trial

Laser acupuncture Conventional antidepressant (doxepin, amitriptyline or aprazolam)

The therapeutic effect was similar in the two groups, somewhat better in the test group for cognitive disturbance. Side-effects occurred in all cases in control group but in none in test group.


Diabetes mellitus, non-insulin-dependent Latief, 1987 (241)


Acupuncture at sânyînjiâo (SP6)

Acupuncture at 1 Chinese inch (cun) superiolateral to SP6

There was a reduction in fasting blood sugar of: • 19.2% in the test group • 4.9% in the control group.

Kang et al., 1995 (240)

12:15: 13:10


Untimed acupuncture or acupuncture at insulin secretion climax (ISCA) or acupuncture at insulin secretion valley (ICSV)

Conventional Western medication (tolbutamide)

Improvement in fasting blood glucose, 2-h glucose, postprandial blood glucose, 24-h urine glucose, and glucosylated haemoglobin was: • marked in the ISCA group • superior in the ISCA group to that in the untimed acupuncture and ISVA groups • similar in the ISCA group to that of the tolbutamide group.

Diarrhoea, see Diarrhoea in infants and children; Dysentery, acute bacillary; Irritable colon syndrome Diarrhoea in infants and young children Li et al., 1997 (213)


Acupuncture at zúsânl? (ST36) and chángqiáng (GV1)

Medication (gentamicin or haloperidol)

Cure in 1 day was obtained in: • 82.3% of the test group (the remainder were cured within 3 days) • 41.3% of the control group.

Yang, 1998 (214)


Body acupuncture and moxibustion

Medication (antibiotics and vitamins)

Cure was obtained in: • 98% of test group within 3.43 ± 0.32 days • 80% of control group within 4.41 ± 0.43 days.

Dysentery, acute bacillary Qiu et al., 1986 (9)


Acupuncture Medication (furazolidone)

Acupuncture relieved symptoms earlier than furazolidone. Stool culture became negative in: • 92.4% of the test group • 98.2% of the control group.

Li, 1990 (8) 276:269 Group comparison

Acupuncture Medication (syntomycin, furazolidone)

Stool culture became negative in all patients after 7 days, but within 7 days in: • 87.7% of the test group; recurrence rate in 1 year, 2.4% • 74.2% of the control group; recurrence rate in 1 year, 2.5%.


Yu et al., 1992 (10)


Acupuncture Medication (furazolidone)

Both treatments relieved symptoms and signs, with no side-effects. Stool culture became negative in: • 128 (79%) in the test group by 5.1 days; recurrence at 9-month follow-up in 4 cases • 143 (87.2%) in the control group by 3.2 days; recurrence at 9-month follow-up in 5 cases.

Dysmenorrhoea, primary Helms, 1987 (153)

11:11:11: 10

Randomized controlled trial, comparing four groups

Acupuncture Placebo acupuncture, no acupuncture but conventional treatment, no acupuncture but conventional treatment and control visits to physician

Improvement was observed in: • 10/11(90.9%) in the real acupuncture group • 4/11 (36.4%) in the placebo acupuncture group • 2/11 (18.2%) in the conventional treatment control group • 1/10 (10%) in the conventional treatment plus visits control group.

Shi et al., 1994 (154)


Acupuncture at sânyînjiâo (SP6)

Medication (a paracetamol-propyphenazone-caffeine combination)

A better and quicker analgesic effect was observed in the test group.

Dysphagia in pseudobulbar paralysis Liu et al., 1998 (255)


Body acupuncture Logemann functional training of lingual muscles

Cure rates after 15 days were: • 26 in the test group (average 8.7 days) • 6 in the control group.

Earache, unexplained Mekhamer A et al. 1987 (222)


Acupuncture Mock TENS The response was significantly better following acupuncture than placebo for both 33% and 50% pain-relief criteria.

Encephalitis, see Viral encephalitis in children Epidemic haemorrhagic fever


Song et al., 1992 (86)


Moxibustion Western medication. (steroid, supportive treatment)

Moxibustion shortened the period of oliguria and accelerated the fall in urine protein and reduction in kidney swelling (ultrasound).

Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm) Xu et al., 1991 (128)


Acupuncture at liángqiû (ST34) and wèishû (BL21)

Conventional medication. (anisodamine)


Yu, 1997 (129) 160:40 Randomized controlled trial

Acupuncture (manual) at zúsânl? (ST36)

Medication (morphine plus atropine)

A marked effect was observed in: • 81% of the test group • 80% of the control group.

Epistaxis, simple (without generalized or local disease) Lang et al., 1995 (223)


Auricular acupuncture with thumb-tack needle

Western medication (carbazochrome salicylate plus vitamin C)

Cure (no recurrence at 3-month follow-up) was observed in: • 84.8% of the test group • 28.6% of the control group.

Eye pain due to subconjunctival injection Shen, 1996 (14) 24:15 Randomized

controlled trial

Acupuncture at bìnào (LI14)

No treatment Pain mostly disappeared in 0.5-1 min in 22/24 of the test group but persisted for 30-60 min in all of the control patients.

Facial pain (including craniomandibular disorders) (see also Temporomandibular joint dysfunction) Hansen et al., 1983 (29)

16 Randomized crossover trial

Acupuncture Sham acupuncture Pain levels were more significantly reduced following acupuncture than following sham acupuncture.

Johansson et al., 1991 (30)

15 per group


Acupuncture Occlusal splint or no treatment

Acupuncture was as effective as occlusal splint. At follow-up, subjective dysfunction scores and visual analogue scale assessments were significantly lower in the test group.

List, 1992 (31) 110 Randomized controlled trial

Acupuncture. Occlusal splint or no treatment

Symptoms were reduced by acupuncture and occlusal-splint therapy. The control group remained essentially unchanged. Acupuncture gave better short-term subjective results than occlusal splint.


Cai, 1996 (28) 32:36 Randomized controlled trial

Acupuncture with retention of needles for 1-1.5 h

Acupuncture with retention of needles for 0.5 h

Marked effect (with effective rate after course of treatment of 14 sessions): • 59.3% of test group after 5 sessions of treatment; overall effective rate, 93.7% • 25% of the control group after 11 sessions on average; overall effective rate, 77.8%.

Facial spasm Liu, 1996 (107) 33:33 Randomized

controlled trial

Wrist-ankle acupuncture

Body acupuncture Elimination of involuntary twitching with no recurrence at 6-month follow-up in: • 69.7% of the test group • 39.4% of the control group.

Female urethral syndrome Zheng et al., 1997 (151)


Body acupuncture and moxibustion.

Medication (Urgenin: herbal extract containing Serenoa serrulata, effective for irritable bladder; used because antibiotics had proved ineffective in all patients)

Effective rates after 1-2 months of treatment were: • 88.3% in the test group • 28% in the control group.

Wang et al., 1998 (150) (from same institute as study above)


Body acupuncture and moxibustion

Medication. (Urgenin; used because antibiotics had proved ineffective)

Effective rates after 1-2 months of treatment were: • 87.5% in the test group (urodynamic study also showed the beneficial effect of acupuncture) • 29.7% in the control group.

Fever, see Convulsions in infants and young children due to high fever; Tonsillitis, acute Fibromyalgia Deluze et al.,1992 (40)


Acupuncture Sham acupuncture There was a significant difference between the two groups with improvement in: • 7 of the 8 parameters in the test group • none of the parameters in the control group.


Gastrointestinal spasm Shi et al., 1995 (130)


Acupuncture Atropine Total relief of pain in 30 min was observed in: • 98 in the test group • 71 in the control group.

Gastrokinetic disturbance Zhang et al., 1996 (131)


Acupuncture Conventional medication (domperidone)

Effective rates (no significant difference between the two groups) were: • 95.2% in the test group • 90.2% in the control group.

Gouty arthritis Li et al., 1993 (60)


Blood-pricking acupuncture

Conventional medication (allopurinol)

The test group showed more marked improvement than the control group. Reduction in blood and urine uric acid was similar in the two groups.

Pan, 1997 (61) 39:20 Randomized controlled trial

Plum-blossom needling plus cupping

Medication (allopurinol) After 6 weeks of treatment, marked improvement was observed in: • 100% of the test group • 65% of the control group.

Haemorrhagic fever, see Epidemic haemorrhagic fever Hay fever, see Allergic rhinitis (including hay fever) Headache Ahonen et al., 1983 (17) (myogenic)


Acupuncture Physiotherapy Significant changes in pain and electromyogram in both groups, with 4 sessions of acupuncture equivalent to 8 sessions of physiotherapy.

Loh et al., 1984 (23) (migraine and tension)

48 Crossover (incomplete)

Acupuncture Standard drug therapy (mainly propranolol)

Benefit was observed in: • 59% of the test group; 39% with marked improvement • 25% of the control group; 11% with marked improvement.


Dowson et al., 1985 (20) (migraine)


Acupuncture Mock TENS 33% severity improvement was observed in: • 56% (14/25) of the acupuncture group • 30% (7/23) of the control group. Headache frequency was reduced in: • 44% (11/25) of the acupuncture group • 57% (13/23) of the control group.

Doerr-Proske et al., 1985 (19) (migraine)

10 per group


Acupuncture Psychological biobehavioural treatment or no treatment (on waiting list)

Over 3 months of treatment, there was a significant reduction of headache frequency and intensity in the acupuncture and psychological biobehavioural groups. There was almost no change in those on the waiting list.

Vincent, 1989 (25) (migraine)


Acupuncture Sham acupuncture There was a significant difference between two groups: the test group experienced sustained improvement over 1 year after only 6 treatments in a 6-week period.

Tavola et al., 1992 (24) (tension)


Acupuncture Sham acupuncture The mean decreases in headache episodes, headache index and analgesic intake, respectively were: • 44.3%, 58.3% and 57.7% in the test group • 21.4%, 27.8% and 21.7% in the control group.

Kubiena et al., 1992 (21) (migraine)


Acupuncture Placebo acupuncture The test group showed better results than the control group (reduction in frequency of attacks, intensity of pain and amount of medication taken).

Xu et al., 1993 (27) (migraine)


Manual acupuncture Electric acupuncture There was an Immediate analgesic effect in: • 80% of the test group • 48% of the control group.

Weinschütz et al., 1994 (26) (migraine)

20:20 Controlled trial, comparable pretreatment conditions

Acupuncture at classical points

Acupuncture at points 1-2 cm from those used in test group

Acupuncture at classical points yielded a significant therapeutic effect superior to the control acupuncture.


Chen et al., 1997 (18) (migraine)


Penetrating acupuncture

Nimodipine After 20 days of treatment, headache disappeared with no recurrence after 6 months of follow-up in: • 30/45 in the test group • 16/30 in the control group.

Liu et al., 1997 (22) (migraine)


Scalp acupuncture Flunarizine Headache was relieved after 1 week treatment in: • 73.3% of the test group • 38.2% of the control group.

Heart disease, see Coronary heart disease (angina pectoris); Pulmonary heart disease, chronic Hepatitis B virus carrier Wang et al., 1991 (85)



Herbal medication (Herba Cymbopogonis)

After 3 months of treatment, carrier status became negative in: • 30% of the test group • 2.4% of the control group. Antibodies to hepatitis B e core antigen were produced in: • 50% of the test group • 6.25% of the control group.

Heroin dependence, see Dependence, opium, cocaine, heroin Herpes zoster (human (alpha) herpesvirus 3) (see also Neuralgia, post-herpetic) Chen et al., 1994 (225)


Laser acupuncture Polyinosinic acid Disappearance of pain and formation of scabs, respectively, occurred after: • 1.48 and 5.76 days of laser acupuncture • 10.5 and 10.4 days of medication.

Hyperlipaemia Wang, 1998 (239)


Acupoint injection plus oral administration of simvastatin

Oral administration of simvastatin

Significant improvement after 30 days of treatment in: • 36/40 (90%) in the test group • 11/25 (44%) in the control group.

Hypertension, essential Iurenev et al., 1988 (173)


Acupuncture Conventional medication (rescinnamine)

The therapeutic efficacy was similar in the two groups.


Zhou et al., 1990 (176)

135:68: 71

Group comparison


Medication (nifedipine plus propranolol) or placebo drug

There was a similar improvement with acupressure and medication. Both were superior to placebo.

Yu et al., 1991 (175)



Conventional medication (reserpine)

There was a similar improvement in the two groups. There were no side-effects in the test group.

Wu et al., 1997 (174)


Scalp acupuncture Conventional medication (nifedipine)

The effects were similar, with no statistically significant difference, in the two groups: • marked response in 47.6%, partial response in 50% of the test group • marked response in 57.6%, partial response in 40.7% of the control group.

Dan, 1998 (172) 26:26 Randomized controlled trial

Acupuncture Conventional medication (nifedipine)

Monitoring of ambulatory blood pressure showed a similar reduction in 24-h systolic and diastolic blood pressure in the two groups. The reduction in myocardial oxygen consumption index was greater in the test group.

Hypo-ovarianism Ma et al., 1997 (256)


Body acupuncture (manual) plus cupping

Medication (diethylstilbestrol)

Marked improvement was observed in: • 43/56 (76.8%) in the test group (hormonal assay showed a further long-term effect after treatment) • 26/55 (47.3%) in the diethylstilbestrol group.

Hypophrenia Tian et al., 1996 (254)


Body plus ear acupuncture plus application of herbal extract to acupoints

No treatment Intelligence quotient increased: • from 53.97 to 65.07 (11.10 ± 2.96) in the test group • from 53.87 to 55.12 in the control group. Social adaptability behaviour increased: • from 7.51 to 8.89 (1.38 ± 0.31) in test group • from 7.57 to 7.82 in the control group.

Hypotension, primary


Guo, 1992 (170) 50:50 Randomized controlled trial


Herbal tonics After 10 days of treatment, blood pressure was restored to normal in: • 45 in the study group (no improvement in 1) • 15 in the control group (no improvement in 25).

Yu et al., 1998 (171)


Acupuncture at bãihuì (GV20) plus herbal medication (Bu Zhong Yi Qi Tang, a formula that is routinely used in herbal medicine for the treatment of hypotension)

Herbal medication (Bu Zhong Yi Qi Tang)

A therapeutic effect was observed after 0.5-1 month of treatment in: • 172/180 (95.5%) in the test group • 46/60 (76.7%) in the control group.

Induction of labour Yu et al., 1981 (161)

10:10:8 Randomized group comparison

Acupuncture at distant points or local points

Acupuncture at distant plus local points

Acupuncture at distant points was superior to that at local points in strengthening uterine contractions for induction of labour. Combined use of distant & local points was best technique.

Lin et al., 1992 (159)


Acupuncture at hég? (LI4) and sânyînjiâo (SP6)

Oxytocin intravenous drip

Similar results were obtained in the two groups, but uterine contractions were less frequent and uterine motility was less marked in the test group.

Ma et al., 1995 (160)

31:29: 15:26


(1) Ear acupuncture at shénmén, (2) Body acupuncture at sânyînjiâo (SP6) or (3) Body acupuncture at yánglíngquán (GB34)

(4) No treatment The duration of labour in the four groups was: • (1) 4.47 ± 0.76 h • (2) 6.80 ± 1.04 h • (3) 9.79 ± 2.45 h • (4) 10.20 ± 2.04h.

Infertility, see Defective ejaculation; Hypo-ovarianism; Infertility due to inflammatory obstruction of fallopian tube; Male sexual dysfunction, non-organic Infertility due to inflammatory obstruction of fallopian tube


Ji et al., 1996 (158)

64:36:30 Randomized controlled trial

Manual acupuncture plus electric acupuncture plus moxibustion

Herbal medication or conventional Western medication (intrauterine injection of gentamicin, chymotrypsin and dexamethasone)

Results showed that the fallopian tube obstruction was totally removed in: • 81.3% of the test group; in a 2-year follow-up, the pregnancy rate was 75% • 55.6% and 56.7% of the control groups, respectively; in a 2-years follow-up, the pregnancy rates were 52.7% and 46.7%.

Insomnia Zhang, 1993 (110)

60 per group

Group comparison


Medication (diazepam plus chlorohydrate)

After 1 month of treatment, sleep was restored to normal or markedly improved in: • 59/60 in the test group • 20/60 in the control group.

Luo et al., 1993 (109)

60 per group



Medication (phenobarbital, methaqualone or meprobamate)

After the course of treatment, sleep improved in: • 96.7% of the test group • 35.0% of the control group.

Irritable bladder, see Female urethral syndrome Irritable colon syndrome Wu et al., 1996 (133)


Moxibustion Western medication After 2.5-3 months of treatment, a therapeutic effect was observed in: • 92.7% of test group (improvement in 53.7%) • 62.5% of control group (improvement in 37.5%).

Knee pain Maruno, 1976 (56) (arthrosis)


Electric acupuncture Manual acupuncture Good results (complete alleviation of pain) were observed in: • 17/26 in the test group (average no. of treatments required, 6) • 11/26 in the control group (average no. of treatments required, 10).


Christensen et al., 1992 (54) (osteoarthritis)

14:15 Randomized controlled trial, independent assessment

Acupuncture No treatment (waiting for surgery)

Reduction in pain, analgesic consumption and objective measurements were significantly greater in the test group.

Berman et al., 1999 (58) (osteoarthritis)


Acupuncture Standard care (weight loss, physical and occupational therapy, medication)

Improvement according to the Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne indices was superior in test group.

Labour, see Induction of labour; Labour pain Labour pain Zhang et al., 1995 (82)


Body plus ear acupuncture

No treatment Acupuncture yielded a good analgesic effect and expedited the opening of the uterine ostium.

Lactation deficiency Chandra et al., 1995 (169)


Electric acupuncture No acupuncture Lactation increased by: • 92% in the test group • 30.9% in the control group. The difference was statistically significant.

Leukopenia Chen et al., 1991 (141) (chemotherapy-induced)

121:117: 34


Acupuncture or moxibustion

Medication (batilol plus cysteine phenylacetate)

Effective rates after 9 days of treatment were: • 88.4% in the acupuncture group • 91.5% in the moxibustion group • 38.2% in the medication group.

Chen et al., 1990 (140) (chemotherapy-induced)


Moxibustion Medication (batilol plus cysteine-phenylacetate)

Effective rates after 9 days of treatment were: • 89.5% in the test group • 38.2% in the control group.


Yin et al., 1990 (143) (benzene-induced)


Acupuncture Medication (cysteine-phenylacetate)

Effective rates after 6 weeks of treatment were: • 83.3% in the test group • 53.4% in the control group.

Yin et al., 1992 (144) (benzene-induced)


Acupuncture Medication (rubidate) Acupuncture was superior to rubidate in improving symptoms and increasing leukocyte count; effective rates were: • 91% in the test group • 68% in the control group.

Wang, 1997 (142) (chemotherapy-induced)


Moxibustion Medication (batilol plus cysteine-phenylacetate)

Effective rates were: • 82% in the test group • 50% in the control group.

Low back pain (see also Sciatica; Spine pain, acute) Gunn et al., 1980 (46)


Acupuncture Standard therapy (physical therapy, remedial exercises, etc.)

Return to original or equivalent work or to lighter work, respectively, was possible in: • 18/29 and 10/29 in the test group • 4/27 and 14/27 in the control group.

Coan et al., 1980 (45)


Acupuncture and electric acupuncture

No treatment (waiting list)

Improvement was observed in: • 19/25 in the test group • 5/25 in the control group.

Mendelson et al., 1983 (49)

95 Randomized single-blind crossover with independent assessment

Acupuncture Lidocaine injection plus sham acupuncture

Improvement was observed in: • 26 in the test group • 22 in the control group.

MacDonald et al., 1983 (48)


Acupuncture and electric acupuncture

Mock TENS Combined average reduction (pain score, activity pain, physical signs) was: • 71.4% in the acupuncture group • 21.4% in the control group.


Lehmann et al., 1986 (47)


Electric acupuncture TENS or mock TENS There was a significantly greater gain in various measures in the test group during a 3-week in-patient treatment period and at 6-month follow-up.

Male sexual dysfunction, non-organic (see also Defective ejaculation) Aydin et al., 1997 (147)


Acupuncture Hypnosis or placebo Success rates were: • 60% in the acupuncture group • 75% in the group treated with hypnotic suggestion • 43-47% in the placebo group.

Malposition of fetus, correction of Qin et al., 1989 (167)



Knee-chest position Success rates were: • 92.9% in the test group • 67.5% in the control group.

Li et al., 1990 (165)


Moxibustion at zúlínqì (GB41)

Moxibustion at zhìyîn (BL67) (not traditionally used for fetal transposition) or at a non-classical point (located 3 cm below the head of the fibula)

After 1 week of treatment, successful transposition occurred in: • 51.9% of the test group • 22.2% and 15%, respectively, in the control groups.

Li et al., 1996 (166)


Electric acupuncture at zhìyîn (BL67)

No treatment Efficacy was markedly superior in the test group.

Cardini et al., 1998 (164)


Moxibustion at zhìyîn (BL67)

Routine care but no intervention for breech presentation

Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1-2 weeks increased fetal activity during the treatment period and resulted in cephalic presentation after treatment period & at delivery.

Ménière disease


Zhang et al., 1983 (219)

33:32 Randomized controlled trial with partial crossover

Acupuncture Conventional Western medication (betahistine, nicotinic acid, vitamin B6, cinnarizine)

After 15 days of treatment, the syndrome was relieved in: • 25 in the test group (ameliorated in 1), with relief usually occurring immediately after treatment • 16 in the control group (ameliorated in 2). Of the 7 unaffected acupuncture patients, 5 returned to receive medication; all remained unimproved. Of the 14 unaffected control patients, 6 returned to receive acupuncture; 2 were cured and 1 improved. Effective rates were: • 74.4% in 39 courses of acupuncture treatment • 48.6% in 37 courses of medication.

Migraine, see Headache Morning sickness (see also Nausea and vomiting) Dundee et al., 1988 (162)

119:112: 119


Acupressure at nèiguân (PC6) or sham acupressure (a point near right elbow)

No treatment Troublesome sickness was significantly less in the acupressure (23/119) and sham acupressure (41/112) groups than in the control group (67/119).

De Aloysio et al., 1992 (258)


Acupressure at nèiguân (PC6)

Sham acupressure Effective rates were: • 60% in the test group • 30% in the control group.

Bayreuther et al., 1994 (259)

23 Randomized single-blind crossover with independent assessment

Acupressure at nèiguân (PC6)

Sham acupressure Effective rates were: • 69% in the test group • 31% in the control group.

Fan, 1995 (163) 151:151 Randomized group comparison

Moxibustion Herbal medication Cure rates after 1 week of treatment were: • 96.7% in the test group • 58.9% in the control group.

Nausea and vomiting (see also Adverse reactions to radiotherapy and/or chemotherapy; Morning sickness)


Dundee et al., 1986 (260) (peri- and postoperative)

25 per group

Group comparison

(1) Acupuncture plus meptazinol, (2) Acupuncture plus nalbuphine

(3) Meptazinol (4) Sham acupuncture plus nalbuphine (5) Nalbuphine

Vomiting in group (1) was half that in group (3). There was a significantly lower incidence of emetic episodes in the acupuncture groups (1) and (2) than in the control groups (3), (4) and (5). There were no differences between the control groups (3), (4) and (5).

Dundee et al., 1987 (233) (cisplatin-associated)


Electric acupuncture at nèiguân (PC6)

Electric acupuncture at “dummy” point

Sickness was significantly lower in the test group.

Ghaly et al., 1987 261) (postoperative)


Acupuncture plus electric acupuncture

Medication (cyclizine) Acupuncture and electric acupuncture were as effective as medication.

Weightman et al., 1987 (262) (postoperative)

46 Double-blind randomized controlled trial

Acupuncture at nèiguân (PC6)

No acupuncture Acupuncture performed during surgery under anaesthesia did not lead to a significant reduction in nausea or vomiting after surgery.

Dundee et al., 1989 (263) (chemotherapy-related)

20 Group comparison


Sham acupuncture Effective rates were: • 90% in the test group • 10% in the control group.

Barsoum et al., 1990 (264) (postoperative)


Acupressure at nèiguân (PC6) by using bands (with pressure button)

Placebo bands (without pressure button) or injection of prochlorperazine

The severity of nausea was significantly reduced in the test group compared with the two control groups.

Ho et al., 1990 (265) (postoperative)

25 per group

Group comparison

Electric acupuncture Medication (intravenous prochlorperazine 5 mg) or TENS or no treatment

Emesis episodes were observed in: • 3/25 in the electric acupuncture group • 3/25 in the medication group • 9/25 in the TENS group • 11/25 in the untreated group.


Ho et al., 1996 (266) (postoperative)

60 Randomized double-blind controlled trial

Acupressure bands (with pressure button)

Placebo bands (without pressure button)

Incidence of nausea and of vomiting, respectively was: • 3% and 0% in the test group • 43% and 27% in the control group.

Andrzejowski et al., 1996 (267) (postoperative)


Acupuncture with semipermanent needles

Placebo with needles inserted into sham points

Semipermanent acupuncture did not reduce the overall incidence of nausea and vomiting after abdominal hysterectomy but did reduce the severity of nausea in the second 24-h period and had a greater effect on patients who had nausea & vomiting after a previous anaesthetic.

McConaghy et al., 1996 (268) (postoperative)



Acupuncture at sham points

Patients were treated with acupuncture with manual stimulation for 4 min after developing post-operative nausea & vomiting lasting more than 10 min: • 53% of patients in the test group did not require further antiemetic treatment • all patients in the control group required further antiemetic treatment.

Schwager et al., 1996 (269) (postoperative)


Acupuncture Placebo (no needle stimulation)

There was no statistically significant difference in total postoperative vomiting between the two groups.

Liu et al., 1997 (270) (cisplatin-associated)

184: 161:25: 25:23: 22:70

Randomized group comparison

Magnetic plate at nèiguân (PC6): (1) 120 mT, (2) 60 mT or (3) 2000 mT

(4) 120 mT magnetic plate at zúsânl? (ST36), (5) iron plate at nèiguân (PC6), (6) steel bead at nèiguân (PC6) or (7) medication (unspecified)

Total effective rates were significantly higher in the first two test groups): • (1) 92.4% • (2) 89.4% • other group rates ranged from 47.2% (7) to 0%.

Al-Sadi et al., 1997 (271) (postoperative)


Acupuncture Placebo (no needle stimulation)

The use of acupuncture reduced the incidence of postoperative nausea or vomiting in hospital from 65% to 35% (for day cases) and from 69% to 31% (after discharge).


Stein et al., 1997 (272) (postoperative)

75 Randomized double-blind controlled trial

Acupressure bands plus intravenous saline

Placebo bands plus intravenous metoclopramide or placebo bands plus intravenous saline

Patients who received either acupressure or placebo bands plus metoclopramide prior to initiation of spinal anaesthesia for caesarean section experienced much less nausea than patients in the placebo band plus saline group.

Schlager et al., 1998 (273) (postoperative)

40:20 Randomized double-blind controlled trial

Laser stimulation of nèiguân (PC6)

Placebo laser The incidence of vomiting after strabismus surgery was significantly different for • 25% in the test group • 85% in the control group.

Chu et al., 1998 (274) (postoperative)

34:31 Randomized controlled trial assessed by evaluator blind to treatment

Acupressure using non-invasive vital point needleless acuplaster (Koa, Japan)

Placebo acupressure The overall incidence of vomiting in a 24-h period after strabismus surgery was: • 29.4% in the test group • 64.5% in the control group.

Alkaissi et al., 1999 (275) (postoperative)

20:20: 20 Randomized controlled trial

Acupressure with wrist band

Placebo with or without wrist band

Nausea decreased after 24 h in all groups but vomiting and need of relief antiemetic was reduced only in the test group.

Shenkman et al., 1999 (276) (postoperative)


Acupuncture plus acupressure

Acupuncture at sham points

Perioperative acupressure and acupuncture did not diminish emesis in children following tonsillectomy.

Neck pain Coan et al., 1982 (35)


Acupuncture plus electric acupuncture

No treatment (waiting list)

Mean pain scores were reduced by: • 40% in the test group; improvement in 12/15 • 2% in the control group; improvement in 2/15.

Loy, 1983 (36) 26:27 Randomized controlled trial

Electric acupuncture Physiotherapy Improvement was observed in: • 67.4% of the test group at 3 weeks, 87.2% at 6 weeks • 51.3% of the control group at 3 weeks, 53.9% at 6 weeks.


Petrie et al., 1986 (37)


Acupuncture Mock TENS At 1-month follow-up, daily pill count and disability scores, respectively: • decreased by 23.5% and 24.6% in the test group • increased by 8.4% and 8.4% in control group.

David et al., 1998 (34)


Acupuncture Physiotherapy Both groups improved in respect of pain and range of movement of neck. Acupuncture was slightly more effective in patients who had higher baseline pain scores.

Birch et al., 1998 (33)


Acupuncture at specific sites relevant for neck pain or acupuncture at specific sites not relevant for neck pain

Nonsteroid anti-inflammatory medication

Relevant acupuncture contributed to modest pain reduction in persons with myofascial neck pain. The relevant acupuncture group had significantly greater pre- and post-treatment differences in pain than the non-relevant acupuncture and medication groups.

Neuralgia, post-herpetic Lewith et al., 1983 (103)


Auricular plus body acupuncture

Placebo (mock TENS) There were no differences in the pain recorded in the two groups during or after treatment. There was a significant improvement in pain at the end of treatment in 7 patients of the placebo group and 7 patients of the acupuncture group.

Sukandar et al., 1995 (104)


Acupuncture at jiáj? (EX-B2) on affected side plus amitriptyline-trifluoperazine combo (amitriptyline 5 mg + trifluoperazine 0.5 mg per tablet), one tablet twice a day

Acupuncture at jiáj? (EX-B2) on contralateral side plus an amitriptyline-trifluoperazine combination

There was a significant difference in analgesia between the test and control groups. Analgesia was excellent in: • all patients in the test group after 6 sessions • none of the patients in the control group.

Neurodermatitis


Huang et al., 1998 (227)


Acupuncture with seven-star needles

Conventional local treatment

Cure rates were: • 100% in the test group • 16.7% in the control group.

Neuropathic bladder in spinal cord injury Cheng et al., 1998 (277)

40:40 Controlled trial

Electric acupuncture Conventional bladder-training programme

Times taken to achieve balanced voiding were: • 57.1 ± 22.6 days in the test group • 85.2 ± 27.4 days in the control group. The difference was statistically significant.

Obesity (see also Simple obesity in children) Richards et al., 1998 (238)



Sham acupuncture Suppression of appetite was noticed in: • 95% of the test group • 0% of the control group.

Opium dependence, see Dependence, opium, cocaine, heroin Osteoarthritis Junnila, 1982 (55)

16:16 Group comparison (sequential)

Acupuncture Medication (piroxicam) Pain was relieved by: • 61% 1 month after a series of acupuncture treatments; no side-effects • 32% after 4 months of piroxicam therapy; itching of the skin, intestinal bleeding, or tiredness occurred in 19%.

Pain, see Abdominal pain in acute gastroenteritis; Biliary colic; Cancer pain; Dental pain; Dysmenorrhoea, primary; Earache; Epigastralgia, acute; Eye pain due to subconjunctival injection; Facial pain (including craniomandibular disorders); Gastrointestinal spasm; Headache; Knee pain; Labour pain; Low back pain; Neck pain; Neuralgia, post-herpetic; Osteoarthritis; Pain due to endoscopic examination; Pain in thromboangiitis obliterans; Periarthritis of shoulder; Plantar pain due to fasciitis; Postoperative pain; Radicular and pseudoradicular pain syndromes; Renal colic; Sciatica; Sore throat; Spine pain, acute; Sprain; Stiff neck; Tennis elbow Pain due to endoscopic examination Wang et al., 1992 (135) (colonoscopy)


Acupuncture Standard medication (scopolamine butylbromide, pethidine)

Analgesia was similar in the two groups but there were significantly fewer side-effects in the test group.


Wang et al., 1997 (136) (colonoscopy)


Electric acupuncture at zúsânl? (ST36) and shàngjùxû (ST37)

Pethidine analgesia Analgesia was similar in the two groups, but there were fewer side-effects in the test group.

Pain in thromboangiitis obliterans Qiu, 1997 (16) 60:30 Group

comparison Body acupuncture (manual)

Medication (intramuscular bucinnazine; also known as bucinperazine)

Effective rates were: • 93.4% in the test group; pain relief started 2-10 min after needling and lasted for 5.6 h • 56.7% in the control group; pain relief started 15-25 min after injection and lasted for 3.1h.

Periarthritis of shoulder Kinoshita, 1973 (38)


Acupuncture at specific & basic points

Acupuncture at basic points alone

The therapeutic effect was superior in the test group; the difference was significant.

Shao, 1994 (39) 62:62 Randomized controlled trial

Acupuncture at èrjiân (LI2)

Acupuncture at traditional points

Cure rates were: • 66.1% in the test group after 2.2 treatments • 31.7% in control groups after 8.2 treatments.

Pertussis, see Whooping cough (pertussis) Plantar pain due to fasciitis Karen et al., 1991 (41)

15 per group


Acupuncture Sham acupuncture or conventional sports therapy

True acupuncture produced greater improvement in pain records than conventional sports therapy at the end of the treatment period (4 weeks) and at the end of the follow-up period (3 weeks). There was also a statistically significant difference between true and sham acupuncture.

Polycystic ovary syndrome (Stein-Leventhal syndrome) Ma et al., 1996 (245)


Manual acupuncture plus electric acupuncture plus moxibustion

Conventional Western medication (clomifene)

Clinical cure (assessment of clinical symptoms, ultrasonic examination and radioimmunoassay of sex hormones) was observed in: • 94% of the test group • 62.5% of the control group.


Postextubation in children Lee et al., 1998 (15)


Acupuncture (blood-letting at shàoshâng (LU11) at the end of operation)

No acupuncture If laryngospasm developed, patients were immediately given acupuncture at shàoshâng (LU11) or zhôngf? (LU1). The laryngospasm was relieved within 1 min in all patients. The incidence of laryngospasm occurring after tracheal extubation in children was: • 5.3% in the test group • 23.7% in the control group.

Postoperative symptoms, closed craniocerebral injury Ding et al., 1997 (252)


Conventional Western medication plus acupuncture

Conventional Western medication (no further details available)

Clinical cure in was observed in: • 13 in the test group; marked improvement in 30; cure and improvement rate, 86% • 7 in the control group; marked improvement in 21; cure and improvement rate, 56%.

Postoperative convalescence Xu, 1998 (101) (hemiplegia after meningioma removal)


Body acupuncture Routine medical treatment (intravenous piracetam)

Improvement of muscular strength and activities after 10 days of treatment was observed in: • 14 in the test group • 8 in the control group.

Postoperative pain Christensen et al., 1989 (72) (after lower abdominal surgery)


Electric acupuncture No treatment The pethidine requirements of each patient were recorded. The quantity of pethidine consumed by the test group was half that consumed by the control group.

Wang et al., 1990 (76) (after tonsillectomy)


Acupuncture Medication (penicillin plus Dobell gargle)

Alleviation of pain, reduction in salivation and speed of wound healing were superior in the test group.


Lü et al., 1993 (74) (after anal surgery)


Acupuncture Bucinnazine A marked analgesic effect was obtained in: • 77% of the test group • 27% of the control group.

Tsibuliak et al., 1995 (75) (various)

229:91: 229

Group comparison

Acupuncture Electric stimulation or narcotic analgesics (omnopon (a Chinese opium alkaloid), trimeperidine)

Although less effective than narcotic analgesics, acupuncture provided adequate analgesia in 50% of patients, & noticeably alleviated severity of postoperative complications (nausea, vomiting, retention of urine, intestinal paresis, impaired drainage function of bronchi).

Felhendler et al., 1996 (278) (after knee arthroscopy)


Acupressure (firm pressure across classical acupoints)

Placebo (light pressure in the same area)

60 min and 24 h after treatment, pain scores on a visual analogue scale were lower in the test group.

Chen et al., 1998 (71) (after abdominal hysterectomy or myomectomy)

25 per group


TENS at zúsânl? (ST36) or dermatomal TENS at the level of the surgical incision

Nonacupoint TENS or sham TENS (no electric current)

Peri-incisional dermatomal TENS and TENS at zusanli were equally effective in decreasing postoperative opioid analgesic requirement and in reducing opioid-related side effects. Both of these treatments were more effective than the nonacupoint or sham TENS.

Premenstrual syndrome Li et al., 1992 (155)


Acupuncture Herbal medication Total relief of symptoms with no recurrence in 6 months of follow-up was observed in: 91.7% of the test group 63% of the control group.

Prostatitis, chronic Luo et al., 1994 (149)


Acupuncture at zhìbiân (BL54) and sânyînjiâo (SP6)

Medication (oral sulfamethoxazole)

Relief of symptoms and improvement in sexual function were superior in the test group.

Pruritus, experimentally induced


Lunderberg et al., 1987 (226)


Manual or electric acupuncture

Placebo acupuncture (superficial insertion of needle with no specific sensation)

Acupuncture and electric acupuncture reduced subjective itch intensity more effectively than placebo acupuncture. The difference was significant. The results suggest that the two test procedures could be tried in clinical conditions associated with pruritus.

Pulmonary heart disease, chronic Zou et al., 1998 (279)


Ginger moxibustion plus acupoint injection

Routine Western treatment (oxygen inhalation, antibiotics and bronchodilators)

After 1.5-2 months of treatment, improvement was observed in: • 27/30 (90%) of the test group; in 1-year follow-up, acute respiratory infection occurred in 7 • 12/29 (41.4%) of the control group; in 1-year follow-up, acute respiratory infection occurred in 26.

Radicular and pseudoradicular pain syndromes Kreczi et al., 1986 (57)

21 Randomized single-blind crossover trial

Laser acupuncture Mock laser acupuncture Laser acupuncture was more effective than placebo in 20 out of 21 patients.

Raynaud syndrome, primary Appiah et al., 1997 (244)


Acupuncture No treatment Mean duration of the capillary flowstop reaction induced by local cooling test decreased from 71 s to 24 s (week 1 compared to week 12, P = 0.001) in test group. Changes in control group weren’t significant. Authors concluded that Chinese acupuncture is a reasonable alternative in treating patients with primary Raynaud syndrome. There was a significant decrease in the frequency of attacks by: 63% in the test group and 27% in the control group.

Recurrent lower urinary-tract infection Aune et al., 1998 (152)


Acupuncture Sham acupuncture or no treatment

Proportions remaining free of lower urinary-tract infection during 6-month observation period were: • 85% in the acupuncture group • 58% in the sham acupuncture group • 36% in the untreated group.


Reflex sympathetic dystrophy Kho, 1995 (280) 28 Double-

blind placebo-controlled trial

Acupuncture Sham acupuncture Acupuncture was beneficial.

Renal colic Lee et al., 1992 (65)


Acupuncture Medication (injection of a metamizole-camylofin combination)

Both groups experienced a significant decrease in pain levels, with the acupuncture group improving slightly more. Side-effects occurred in: • 0/22 in the test group • 7/16 in the control group.

Zhang et al., 1992 (7)


Acupuncture Medication (injection of atropine plus pethidine)

An analgesic effect was observed in: • 99.2% of the test group • 71.2% of the control group.

Li et al., 1993 (66)


Acupuncture Medication (injection of atropine plus promethazine and bucinnazine)

Relief of pain was observed in: • all patients in the test group in 25 min on average • 90% of the patients in the control group in 50 min.

Retention of urine, traumatic Pan et al., 1996 (146)


Acupuncture Medication (intramuscular neostigmine bromide)

The therapeutic effect of acupuncture was markedly superior to that of neostigmine injection.

Retinopathy, central serous Yu et al., 1997 (281)


Acupuncture (manual)

Medication (rutoside, vitamin C, troxerutin)

Cure rates were: • 46/86 (49.5%) eyes in test group; average duration of treatment required, 50.6 days • 52/146 (35.6%) eyes in control group; average duration of treatment required, 63.6 days.

Rheumatoid arthritis


Man et al., 1974 (4)


Electric acupuncture Sham acupuncture Pain relief was observed in: • 90% of the treatment group • 10% of the control group.

Ruchkin et al., 1987 (5)

10:6 Double-blind controlled trial

Auricular electric-acupuncture

Sham electric acupuncture (no electrical stimulation)

Subjective improvement was observed in: • all patients in the test group • 1 patient in the control group.

Sun et al., 1992 (6)


Warming acupuncture

Acupuncture Marked improvement was observed in: • 65.5% of the test group • 26.8% of the control group.

Schizophrenia Jia et al., 1986 (195)

24:13 Controlled trial

Laser acupuncture Medication (chlorpromazine)

After 6 weeks of treatment, marked improvement was observed in: • 78% of the test group • 39% of the control group.

Zhang et al., 1994 (282)


Electric acupuncture plus conventional medication (various)

Conventional medication (various)

The therapeutic effect was significantly greater in the test group.

Sciatica Kinoshita, 1971 (50)


Acupuncture with deep insertion of needles (10-30 mm)

Acupuncture with superficial puncture (5 mm)

The therapeutic effect was greater in the test group. The difference was statistically significant.

Kinoshita, 1981 (51)


Acupuncture at dàchángshû (BL25) with deep puncture (6 cm)

Acupuncture with superficial puncture (2 cm)

The therapeutic effect on tenderness, Lasegue’s sign, and subjective symptoms was greater in the test group. The difference was significant.

Shen, 1987 (53) 50:50 Group comparison

Long-needle acupuncture

Classical acupuncture Effective rates were: • 96% of the test group • 72% of the control group.


Li, 1991 (52) 100:70 Group comparison

Acupuncture at xiazhibian

Acupuncture at zhìbiân (BL54)

Effective rates were: • 98% of test group after 15.8 treatments, on average • 81.4% of the control group after 27.7 treatments.

Sexual dysfunction, see Defective ejaculation; Male sexual dysfunction, non-organic Sialorrhoea, antipsychotic-induced Xiong et al., 1993 (242)


Acupuncture Anisodamine After 10 days of treatment, marked reduction in salivation was achieved in: • 96.7% of the test group • 35.9% of the control group.

Simple obesity in children Yu et al., 1998 (283)

101:101: 50


Photo-acupuncture or auricular acupressure

No treatment The effects of photo-acupuncture and auricular acupressure were satisfactory, with better results for the former. After 3 months of acupuncture treatment, the obesity indices decreased significantly and levels of blood lipids, glucose, hydrocortisone and triiodothyronine were all markedly improved.

Sjögren syndrome List et al., 1998 (243)


Acupuncture No treatment A significant increase in paraffin-stimulated saliva secretion was found in both groups. There were no statistically significant differences in unstimulated salivary secretion between groups. The study showed that acupuncture is of limited value for patients with primary Sjögren syndrome.

Small airway obstruction Chen et al., 1997 (284)


Body acupuncture (40 min)

Body acupuncture (20 min and 60 min)

Small airway function in bronchial asthma and chronic bronchitis improved in all three groups. The best result was obtained in the test group.

Smoking, see Dependence, tobacco Sore throat (see also Tonsillitis, acute)


Gunsberger, 1973 (118)

100 per group

Group comparison

Acupuncture at a single point or at 2 points

No treatment (acupuncture refusers) or petroleum jelly placebo

Results in the two treatment groups were significantly better than in the two control groups. At 48 h, 90% of those receiving acupuncture at 2 points were still reporting pain relief compared with only 30% of those receiving no treatment.

Spine pain, acute (see also Low back pain; Sciatica) Santiesteban, 1984 (285)


Electric acupuncture Selected physical therapy

The test group showed significant increases in range of motion, straight leg raising, & decreased pain immediately after treatment. Control group showed no improvement.

Sprain Jiao, 1991 (68) (limb)


Acupuncture Physiotherapy Pain was relieved after 1 session of treatment in: • 32% of the test group (in 84% after 9 sessions) • 0% of the control group (in 18% after 9 sessions).

Jin, 1991 (69) (lumbar)


Hand acupuncture Medication (analgesic) Pain was relieved and function restored in: • 1-3 days (average 1.06 days) in test group • 3-10 days (average 4.38 days) in control group.

Zheng, 1997 (70) (lumbar)


Hand acupuncture Body acupuncture Cure (disappearance of symptoms, free movement of the lower back, and no recurrence in 3 years) immediately after 1 session of treatment in: • 82.4% of the test group • 52.9% of the control group.

Stiff neck Wu, 1997 (286) 100:32 Group

comparison Acupuncture at laozhen

Medication (ibuprofen 0.3 g, 3 times per day)

Cure was observed in: • 80/100 (80%) in the test group after the first session, 10 after the second, and 4 after the third; 6 did not respond in 3 days • 12/32 (38%) in the control group on the first day, 6 on the second, and 2 on the third; 12 did not respond in 3 days.

Stroke Chen et al., 1990 (89) (ischaemic))

20 per group


Acupuncture Medication (mannitol, dextrose, citicoline)

A better therapeutic effect (as assessed by EEG-map and somatosensory-evoked potential) was observed in the test group.


Zou et al., 1990 (287) (ischaemic)


Acupuncture Medication (vinpocetine)

A better therapeutic effect was observed in the test group.

Bai et al., 1993 (88) (ischaemic)

40 per group


Acupuncture Medication Beniol (a Chinese medicine containing linoleic acid, inositol & other vitamins), troxerutin, nimodipine)

A better neurological outcome was observed in the test group.

Hu et al., 1993 (94) (ischaemic)


Physiotherapy plus acupuncture

Physiotherapy A better neurological outcome was observed for physiotherapy plus acupuncture than for physiotherapy alone.

Jin et al., 1993 (99) (hemiplegia after stroke)


Temporal acupuncture

Traditional body acupuncture

Significantly better results were obtained in the test group.

Liang, 1993 (100) (sequelae of stroke)


Temporal acupuncture

Traditional body acupuncture

Significantly better results were obtained in the test group.

Johansson et al., 1993 (95) (sequelae of stroke)


Acupuncture plus physiotherapy and occupational therapy

Physiotherapy and occupational therapy

A more rapid and more complete recovery was observed in the test group.

Zhang et al.,1994 (102) (stroke with aphasia)


Scalp electric acupuncture

No treatment A more rapid and more complete recovery observed in the test group.

Liao, 1997 (91) (hemiplegia after stroke)


Acupuncture at sh?usânl? (LI10) and fútù (ST32)

Routine medication plus hyperbaric oxygenation

Marked improvement after 20 days of treatment was observed in: • 66.7% of the test group • 29.0% of the control group.


Jiang et al., 1997 (90) (spontaneous limb pain after stroke)


Electric acupuncture Conventional Western medication (carbamazepine)

After 30 days of treatment, the two groups showed similar amelioration of pain. Effective rates were: 90% in the test group 86.7% in the control group.

Liu et al., 1997 (92) (myodynamia after stroke)


Scalp or body acupuncture

Medication Functional recovery was observed in: • 75.6% of the scalp acupuncture group; total effective rate 98.7% • 51.8% of the body acupuncture group; total effective rate 92.8% • 16.7% control group; total effective rate 80%.

Kjendahl et al., 1997 (97) (subacute stroke)


Rehabilitation programme plus acupuncture

Rehabilitation programme

The test group improved significantly more than the control group during the treatment period of 6 weeks, and even more during the following year, according to motor-assessment scale, ADL, Nottingham health profile and social situation.

Gosman-Hedstrom et al., 1998 (96) (acute stroke)


Conventional rehabilitation plus deep acupuncture

Conventional rehabilitation plus superficial acupuncture or conventional rehabilitation alone

There were no differences between the groups in respect of changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months.

Si et al., 1998 (93) (acute ischaemic stroke)


Electric acupuncture plus medication

Medication Clinical functional recovery was significantly better in the test group.

Wong et al., 1999 (98) (hemiplegia after stroke)


Electric acupuncture plus rehabilitation

Rehabilitation Patients in the test group had a shorter hospital stay for rehabilitation and better neurological and functional outcomes than those in the control group, with a significant difference in scores for self-care and locomotion.

Temporomandibular joint dysfunction (see also Facial pain, including craniomandibular disorders) Raustia et al., 1986 (288)


Acupuncture Standard stomatognathic treatment

Both treatments resulted in a significant reduction in symptoms and signs. Acupuncture seems to be useful as a complementary treatment, especially in cases with evidence of physiological or neuromuscular disturbances.

Tennis elbow


Brattberg, 1983 (42)


Acupuncture Steroid injection Improvement was observed at follow-up in: • 61.8% of the test group • 30.8% of the control group.

Haker et al., 1990 (43)


Classical acupuncture

Superficial acupuncture Short-term improvement was significantly greater in the test group.

Molsberger et al., 1994 (44)

24:24 Placebo-controlled, single-blind trial with independent evaluation

Acupuncture Placebo (acupuncture. avoiding penetration of the skin)

Pain relief of at least 50% after 1 treatment was reported by: • 19 of the test group; average duration of analgesia after 1 treatment, 20.2 h • 6 of the control group; average duration of analgesia after 1 treatment, 1.4h.

Tietze syndrome Yang, 1997 (246)


Acupuncture (manual) plus cupping

Routine medication (oral indometacin and local injection of prednisolone or procaine) plus physiotherapy

After 3 weeks of treatment, cure was observed in: • 70/108 (64.8%) in the test group • 24/64 (37.5%) in the control group.

Tinnitus Jin et al., 1998 (220) (subjective)


Body acupuncture Routine medication, including anisodamine

After 6 weeks of treatment cure was observed in: • 8 (22.9%) in the test group; 10 (28.6%) markedly improved • 2 (5.7%) in the control group; 6 (17.1%) markedly improved.

Vilholm et al., 1998 (221) (severe)

54 Randomized controlled crossover trial

Body acupuncture Placebo There was no statistically significant difference between the two groups.

Tonsillitis, acute Chen, 1987 (117) 220:50 Group

comparison Acupuncture Antibiotics (penicillin,

etc.) Earlier relief of fever and sore throat was observed in the test group.


Tourette syndrome Tian et al., 1996 (217)


Body acupuncture plus auricular acupressure

Conventional Western medication (haloperidol)

Cure was observed in: • 30.9% of the test group; effective rate at 6-month follow-up, 46/57 (89.7%) • 11.8% of the control group; effective rate at 6-month follow-up, 5/13 (69.7%) in the control group.

Jin, 1998 (216) 30:30 Randomized controlled trial

Body acupuncture plus auricular acupressure

Conventional Western medication (haloperidol)

After 1 month of treatment, clinical cure with no recurrence at 6-month follow-up in: • 30.0% of test group; overall effective rate 93.4% • 6.7% of control group; overall effective rate 76.7%.

Ulcerative colitis, chronic Wu et al., 1995 (134)


Moxibustion with herbal partition

Sulfasalazine After 3 months of treatment, clinical cure was observed in: • 13/24 (54%) in test group; improvement in 10 • 3/11 (27%) in the control group; improvement in 4. The difference was significant.

Ma et al., 1997 (289)


Body acupuncture plus moxibustion.

Sulfasalazine plus metronidazole

After 30 days of treatment, cure (assessed both clinically and endoscopically) was observed in: • 76.7% of the test group • 56.7% of the control group.

Urinary tract problems, see Female urethral syndrome; Neuropathic bladder in spinal cord injury; Recurrent lower urinary tract infection; Renal colic; Urolithiasis Urolithiasis Zhang et al., 1992 (7)


Acupuncture Fluid infusion plus herbal medication)

Cure (elimination of symptoms and signs and no residual stones revealed by X-ray or ultrasound examination) was observed in: • 90.48% of the test group • 33.05% of the control group.

Vascular dementia Lai, 1997 (290) 30:30 Randomized

controlled trial

Manual plus electric acupuncture

Aniracetam Improvement after 6 weeks of treatment was observed in: • 26 (86.7%) of the test group • 19 (63.3%) of the control group.


Liu et al., 1998 (291)

60:60: 30:30


(1) Scalp electric acupuncture

(2) Nimodipine, (3) Electric acupuncture plus medication (nimodipine), or (4) No treatment

Assessment by various neuropsychological scales showed that effects of test & control procedures were comparable. After 8 weeks of treatment, assessment (of memory, intelligence and ability to take care of oneself) showed improvement in: • 68.3% of group (1) • 71.6% of group (2) • 73.3% of group (3) • 23.3% of group (4).

Condition/Study No. Design Test group Control Group Results Jiang et al., 1998 (292)


Electric acupuncture Dihydroergotoxine Results were superior in the test group, as assessed by the Hasegawa dementia scale and functional activities questionnaire, increase in superoxide dismutase and decreases in lipid peroxide and nitric oxide.

Viral encephalitis in children, late stage Wang, 1998 (293)


Scalp electric and manual acupuncture plus routine medication as for control group

Routine medication (including antiviral and anti-inflammatory agents, and nutrients for brain tissue)

Effective rates were: • 59/72 (81.9%) in the test group • 19/42 (45.2%) in the control group.

Whooping cough (pertussis) Yao et al., 1996 (87)


Acupuncture at bâxié(EX-UE9)

Chloramphenicol intravenous drip

After 7 days of treatment, cure was observed in: • 98.6% of the test group • 10% of the control group.

Novembre - dicembre 2011 - KAM FOR SUD...Novembre - dicembre 2011 Patrick Grassi Civilista •...

Documents

Transcript of Novembre - dicembre 2011 - KAM FOR SUD...Novembre - dicembre 2011 Patrick Grassi Civilista •...